Related Experiment Video
Updated: Nov 3, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Can Preoperative Mapping with Functional MRI Reduce Morbidity in Brain Tumor Resection? A Systematic Review and
Licia P Luna1, Farzaneh Ghazi Sherbaf1, Haris I Sair1
1From the Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe St, Phipps B100F, Baltimore, MD 21287 (L.P.L., F.G.S., H.I.S.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Md (D.M.); Department of Radiology, Hospital Geral de Fortaleza, Fortaleza, Brazil (I.B.O.); and Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil (C.A.K.).
Abstract:
Background Preoperative functional MRI (fMRI) is one of several techniques developed to localize critical brain structures and brain tumors. However, the usefulness of fMRI for preoperative surgical planning and its potential effect on neurologic outcomes remain unclear. Purpose To assess the overall postoperative morbidity among patients with brain tumors by using preoperative fMRI versus surgery without this tool or with use of standard (nonfunctional) neuronavigation. Materials and Methods A systematic review and meta-analysis of studies across major databases from 1946 to June 20, 2020, were conducted. Inclusion criteria were original studies that (a) included patients with brain tumors, (b) performed preoperative neuroimaging workup with fMRI, (c) investigated the usefulness of a preoperative or intraoperative functional neuroimaging technique and used that technique to resect cerebral tumors, and (d) reported postoperative clinical measures. Pooled estimates for adverse event rate (ER) effect size (log ER, log odds ratio, or Hedges g) with 95% CIs were computed by using a random-effects model. Results Sixty-eight studies met eligibility criteria (3280 participants; 58.9% men [1555 of 2641]; mean age, 46 years ± 8 [standard deviation]). Functional deterioration after surgical procedure was less likely to occur when fMRI mapping was performed before the operation (odds ratio, 0.25; 95% CI: 0.12, 0.53; P < .001]), and postsurgical Karnofsky performance status scores were higher in patients who underwent fMRI mapping (Hedges g, 0.66; 95% CI: 0.21, 1.11; P = .004]). Craniotomies for tumor resection performed with preoperative fMRI were associated with a pooled adverse ER of 11% (95% CI: 8.4, 13.1), compared with a 21.0% ER (95% CI: 12.2, 33.5) in patients who did not undergo fMRI mapping. Conclusion From the currently available data, the benefit of preoperative functional MRI planning for the resection of brain tumors appears to reduce postsurgical morbidity, especially when used with other advanced imaging techniques, such as diffusion-tensor imaging, intraoperative MRI, or cortical stimulation. © RSNA, 2021 Online supplemental material is available for this article.
Insights
Preoperative functional MRI (fMRI) significantly reduces the risk of functional decline and improves outcomes for brain tumor surgery. This neuroimaging technique lowers postsurgical adverse event rates compared to standard procedures.
Area of Science:
- Neurosurgery
- Neuroradiology
- Medical Imaging
Background:
- Preoperative functional MRI (fMRI) is a technique for localizing critical brain structures and tumors.
- Its utility in surgical planning and impact on neurological outcomes remain under investigation.
- Assessing fMRI's role in reducing postoperative morbidity in brain tumor patients is crucial.
Purpose of the Study:
- To evaluate the overall postoperative morbidity in brain tumor patients.
- Compare outcomes between surgeries using preoperative fMRI and those without or with standard neuronavigation.
Main Methods:
- Systematic review and meta-analysis of studies from 1946 to June 2020.
- Inclusion criteria: brain tumor patients, preoperative fMRI, tumor resection using functional neuroimaging, and reported postoperative measures.
- Random-effects model used to compute pooled estimates for adverse event rates and effect sizes.
Main Results:
- Sixty-eight studies (3280 participants) were included.
- fMRI mapping was associated with a lower likelihood of functional deterioration (OR, 0.25; P < .001) and higher Karnofsky scores (Hedges g, 0.66; P = .004).
- Adverse event rate for craniotomies with fMRI was 11%, compared to 21.0% without fMRI.
Conclusions:
- Preoperative fMRI planning for brain tumor resection appears to reduce postsurgical morbidity.
- Benefits are enhanced when fMRI is combined with advanced techniques like diffusion-tensor imaging or intraoperative MRI.
- fMRI is a valuable tool for improving patient outcomes in neurosurgical oncology.
More Related Videos
09:16Study Design for Navigated Repetitive Transcranial Magnetic Stimulation for Speech Cortical Mapping
Published on: March 24, 2023
13:12Translational Brain Mapping at the University of Rochester Medical Center: Preserving the Mind Through Personalized Brain Mapping
Published on: August 12, 2019