What Can Neurosurgical Pediatric Populations Do in Functional Magnetic Resonance Imaging? Brain Activity Mapping...

Background/Objectives: Performing presurgical functional magnetic resonance imaging (fMRI) mapping in young patients is considered a challenge for clinicians, as fMRI maps are the sole source of information about the functional organization of cognitive functions/areas, especially when an awake craniotomy is not possible, as is often the case for pediatric populations. The literature on the fMRI tasks used in pediatric populations with brain injuries shows a certain heterogeneity in the approaches (task-based or resting states) and tasks, with a preference for motor/language mapping: tasks assessing extra-language functions are lacking. Methods: We have designed fMRI tasks focused on language and extra-language functions, which can be easily be applied when clinicians need to perform presurgical mapping. We present a retrospective case series of 17 patients. Results: Seventeen young patients (13.4 ± 2.8 years; range 7-16) were included in the study, for whom fMRI was performed. All underwent successful fMRI mapping by completing fMRI tasks selected based on their lesion site. The number of tasks performed by each patient significantly correlated with their age (r(17) = 0.561, p = 0.019). The patients tolerated the assessment and had good motion control: their movement parameters were minimal (range of rotation of -0.015-0.01 degrees; range of translation of -0.8-0.2 mm). The most administered fMRI tasks were tongue motor localizer (60%) and object naming (70%), with some patients performing extra-language function mapping involving visuo-spatial processing, selective attention, memory, and inhibition. Conclusions: This is an exploratory study given the sample size. fMRI measurements were considered feasible, as patients were able to complete the tasks under clinically realistic conditions. We discuss the clinical implication/usefulness of administering tasks for a personalized functional assessment of the young patient before surgery.