Functional MRI-guided surgery of intracranial tumors

We describe a technique of registering functional magnetic resonance image (fMRI) data sets with the anatomical images used for intraoperative navigation. Three patients with supratentorial tumors were studied, 2 with astrocytomas and 1 with a meningioma. The day before surgery, a functional blood-oxygen-level-dependent MR scan was done. During the same imaging session, an anatomic stereotactic MR scan was performed. The raw data were reconstructed off line on a workstation, and the fMR maps were then registered to the anatomic studies using image header information. Fused images were then transferred to the navigational workstation over an Ethernet connection. At surgery, brain exposure was performed in a standard manner. In each case, the registered scans accurately localized the motor and/or sensory cortex. No new permanent neurological deficits resulted from surgery. The potential advantages of fMRI-guided surgery include: (1) smaller brain exposures; (2) localization of language cortex under general anesthesia; (3) mapping of multiple functional sites, with decreased time and increased case of surgery.