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Resting-state functional magnetic resonance imaging for surgical planning in pediatric patients: a preliminary
Jarod L Roland1, Natalie Griffin2, Carl D Hacker1
1Departments of1Neurological Surgery.
Insights
Resting-state functional MRI (rs-fMRI) offers noninvasive cerebral mapping for pediatric neurosurgery, benefiting patients who cannot cooperate with traditional methods. This technique enables individual-based network mapping for surgical planning, even under anesthesia.
Area of Science:
- Neurosurgery
- Neuroimaging
- Pediatric Medicine
Background:
- Pediatric neurosurgical planning faces challenges with cooperative capacity.
- Traditional cerebral mapping techniques are often unsuitable for young patients.
- Resting-state functional MRI (rs-fMRI) offers a noninvasive alternative requiring minimal cooperation.
Observation:
- rs-fMRI was applied to 20 pediatric patients undergoing craniotomy for surgical planning.
- The technique utilized a machine-learning algorithm for individual resting-state network identification.
- Sedation was required for 6 patients, and 5 also underwent task-based fMRI.
Findings:
- rs-fMRI successfully generated individual cerebral network maps for surgical navigation.
- The technique proved effective even in sedated pediatric patients.
- Feasibility was demonstrated for integrating rs-fMRI into clinical pediatric neurosurgery.
Implications:
- rs-fMRI is a promising tool for cerebral mapping in pediatric neurosurgery.
- Its noninvasive nature and lack of cooperation requirement make it ideal for this population.
- This study highlights the potential of rs-fMRI for improved surgical planning and outcomes in children.
Abstract:
OBJECTIVE Cerebral mapping for surgical planning and operative guidance is a challenging task in neurosurgery. Pediatric patients are often poor candidates for many modern mapping techniques because of inability to cooperate due to their immature age, cognitive deficits, or other factors. Resting-state functional MRI (rs-fMRI) is uniquely suited to benefit pediatric patients because it is inherently noninvasive and does not require task performance or significant cooperation. Recent advances in the field have made mapping cerebral networks possible on an individual basis for use in clinical decision making. The authors present their initial experience translating rs-fMRI into clinical practice for surgical planning in pediatric patients. METHODS The authors retrospectively reviewed cases in which the rs-fMRI analysis technique was used prior to craniotomy in pediatric patients undergoing surgery in their institution. Resting-state analysis was performed using a previously trained machine-learning algorithm for identification of resting-state networks on an individual basis. Network maps were uploaded to the clinical imaging and surgical navigation systems. Patient demographic and clinical characteristics, including need for sedation during imaging and use of task-based fMRI, were also recorded. RESULTS Twenty patients underwent rs-fMRI prior to craniotomy between December 2013 and June 2016. Their ages ranged from 1.9 to 18.4 years, and 12 were male. Five of the 20 patients also underwent task-based fMRI and one underwent awake craniotomy. Six patients required sedation to tolerate MRI acquisition, including resting-state sequences. Exemplar cases are presented including anatomical and resting-state functional imaging. CONCLUSIONS Resting-state fMRI is a rapidly advancing field of study allowing for whole brain analysis by a noninvasive modality. It is applicable to a wide range of patients and effective even under general anesthesia. The nature of resting-state analysis precludes any need for task cooperation. These features make rs-fMRI an ideal technology for cerebral mapping in pediatric neurosurgical patients. This review of the use of rs-fMRI mapping in an initial pediatric case series demonstrates the feasibility of utilizing this technique in pediatric neurosurgical patients. The preliminary experience presented here is a first step in translating this technique to a broader clinical practice.
