Functional image—guided surgery of intracranial tumors located in or near the sensorimotor cortex

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  • 1 Sections of Neurosurgery and Neuroradiology, New Jersey Medical School, Newark, New Jersey
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Object. The purpose of this study was to evaluate the efficacy of noninvasive preoperative functional imaging data used in an interactive fashion in the operating room. The authors describe a method of registering preoperative functional magnetic resonance (fMR) imaging localization of sensorimotor cortex with a frameless stereotactic surgical navigation device.

Methods. The day before surgery, patients underwent blood oxygen level—dependent fMR imaging while performing a finger-tapping motor paradigm. Immediately afterward an anatomical stereotactic MR image was acquired. Raw fMR imaging data were analyzed offline at a separate workstation, and the resulting functional maps were registered to a high-resolution anatomical scan. The fused functional—anatomical images were then downloaded onto a surgical navigation computer via an ethernet connection. At surgery, the brain was exposed in the standard fashion, and the sensorimotor cortex was identified by direct cortical stimulation, the use of somatosensory evoked potentials, or both. This localization was then compared with that predicted by the registered fMR study.

Thirteen procedures were performed in 12 patients. The mean registration error was 2.2 mm. The predicted location of motor and/or sensory cortex matched that found on intraoperative mapping in all 12 patients tested. Maximal tumor resection was accomplished in each case and no new permanent neurological deficits resulted.

Conclusions. Compared with conventional brain mapping techniques, fMR image—guided surgery may allow for smaller brain exposures, localization of the language cortex with the patient under general anesthesia, and the mapping of multiple functional sites. The scanning equipment used in this method may be more readily available than for other functional imaging techniques such as positron emission tomography or magnetoencephalography.

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  • 1.

    Ammirati M, , Vick N, & Liao Y, et al: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery 21:201206, 1987 Ammirati M, Vick N, Liao Y, et al: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery 21:201–206, 1987

    • Search Google Scholar
    • Export Citation
  • 2.

    Atlas SW, , Howard RS II, & Maldjian J, et al: Functional magnetic resonance imaging of regional brain activity in patients with intracerebral gliomas: findings and implications for clinical management. Neurosurgery 38:329338, 1996 Atlas SW, Howard RS II, Maldjian J, et al: Functional magnetic resonance imaging of regional brain activity in patients with intracerebral gliomas: findings and implications for clinical management. Neurosurgery 38:329–338, 1996

    • Search Google Scholar
    • Export Citation
  • 3.

    Bandettini PA, , Jesmanowicz A, & Wong EC, et al: Processing strategies for time-course data sets in functional MRI of the human brain. Magn Reson Med 30:161173, 1993 Bandettini PA, Jesmanowicz A, Wong EC, et al: Processing strategies for time-course data sets in functional MRI of the human brain. Magn Reson Med 30:161–173, 1993

    • Search Google Scholar
    • Export Citation
  • 4.

    Barnett GH, , Kormos DW, & Steiner CP, et al: Intraoperative localization using an armless, frameless stereotactic wand. Technical note. J Neurosurg 78:510514, 1993 Barnett GH, Kormos DW, Steiner CP, et al: Intraoperative localization using an armless, frameless stereotactic wand. Technical note. J Neurosurg 78:510–514, 1993

    • Search Google Scholar
    • Export Citation
  • 5.

    Barnett GH, , Kormos DW, & Steiner CP, et al: Use of a frameless, armless stereotactic wand for brain tumor localization with two-dimensional and three-dimensional neuroimaging. Neurosurgery 33:674678, 1993 Barnett GH, Kormos DW, Steiner CP, et al: Use of a frameless, armless stereotactic wand for brain tumor localization with two-dimensional and three-dimensional neuroimaging. Neurosurgery 33:674–678, 1993

    • Search Google Scholar
    • Export Citation
  • 6.

    Belliveau JW, , Kennedy DN, & McKinstry RC, et al: Functional mapping of the human visual cortex by magnetic resonance imaging. Science 254:716719, 1991 Belliveau JW, Kennedy DN, McKinstry RC, et al: Functional mapping of the human visual cortex by magnetic resonance imaging. Science 254:716–719, 1991

    • Search Google Scholar
    • Export Citation
  • 7.

    Benzel EC, , Lewine JD, & Bucholz RD, et al: Magnetic source imaging: a review of the Magnes system of Biomagnetic Technologies Incorporated. Neurosurgery 33:252259, 1993 Benzel EC, Lewine JD, Bucholz RD, et al: Magnetic source imaging: a review of the Magnes system of Biomagnetic Technologies Incorporated. Neurosurgery 33:252–259, 1993

    • Search Google Scholar
    • Export Citation
  • 8.

    Berger MS, , Cohen WA, & Ojemann GA: Correlation of motor cortex brain mapping data with magnetic resonance imaging. J Neurosurg 72:383387, 1990 Berger MS, Cohen WA, Ojemann GA: Correlation of motor cortex brain mapping data with magnetic resonance imaging. J Neurosurg 72:383–387, 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    Berger MS, , Kincaid J, & Ojemann GA, et al: Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. Neurosurgery 25:786792, 1989 Berger MS, Kincaid J, Ojemann GA, et al: Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. Neurosurgery 25:786–792, 1989

    • Search Google Scholar
    • Export Citation
  • 10.

    Binder J: Functional magnetic resonance imaging. Language mapping. Neurosurg Clin North Am 8:383392, 1997 Binder J: Functional magnetic resonance imaging. Language mapping. Neurosurg Clin North Am 8:383–392, 1997

    • Search Google Scholar
    • Export Citation
  • 11.

    Cao Y, , Towle VL, & Levin DN, et al: Functional mapping of human motor cortical activation with conventional MR imaging at 1.5 T. J Magn Reson Imaging 3:869875, 1993 Cao Y, Towle VL, Levin DN, et al: Functional mapping of human motor cortical activation with conventional MR imaging at 1.5 T. J Magn Reson Imaging 3:869–875, 1993

    • Search Google Scholar
    • Export Citation
  • 12.

    Fried I, , Nenov VI, & Ojemann SG, et al: Functional MR and PET imaging of rolandic and visual cortices for neurosurgical planning. J Neurosurg 83:854861, 1995 Fried I, Nenov VI, Ojemann SG, et al: Functional MR and PET imaging of rolandic and visual cortices for neurosurgical planning. J Neurosurg 83:854–861, 1995

    • Search Google Scholar
    • Export Citation
  • 13.

    Ganslandt O, , Steinmeier R, & Kober H, et al: Magnetic source imaging combined with image-guided frameless stereotaxy: a new method in surgery around the motor strip. Neurosurgery 41:621628, 1997 Ganslandt O, Steinmeier R, Kober H, et al: Magnetic source imaging combined with image-guided frameless stereotaxy: a new method in surgery around the motor strip. Neurosurgery 41:621–628, 1997

    • Search Google Scholar
    • Export Citation
  • 14.

    Germano IM: The NeuroStation System for image-guided, frameless stereotaxy. Neurosurgery 37:438350, 1995 Germano IM: The NeuroStation System for image-guided, frameless stereotaxy. Neurosurgery 37:438–350, 1995

    • Search Google Scholar
    • Export Citation
  • 15.

    Golfinos JG, , Fitzpatrick BC, & Smith LR, et al: Clinical use of a frameless stereotactic arm: results of 325 cases. J Neurosurg 83:197205, 1995 Golfinos JG, Fitzpatrick BC, Smith LR, et al: Clinical use of a frameless stereotactic arm: results of 325 cases. J Neurosurg 83:197–205, 1995

    • Search Google Scholar
    • Export Citation
  • 16.

    Haglund MM, , Berger MS, & Shamseldin M, et al: Cortical localization of temporal lobe language sites in patients with gliomas. Neurosurgery 34:567576, 1994 Haglund MM, Berger MS, Shamseldin M, et al: Cortical localization of temporal lobe language sites in patients with gliomas. Neurosurgery 34:567–576, 1994

    • Search Google Scholar
    • Export Citation
  • 17.

    Hamilton RJ, , Sweeney PJ, & Pelizzari CA, et al: Functional imaging in treatment planning of brain lesions. Int J Radiat Oncol Biol Phys 37:181188, 1997 Hamilton RJ, Sweeney PJ, Pelizzari CA, et al: Functional imaging in treatment planning of brain lesions. Int J Radiat Oncol Biol Phys 37:181–188, 1997

    • Search Google Scholar
    • Export Citation
  • 18.

    Hayashi N, , Endo S, & Kurimoto M, et al: Functional image-guided neurosurgical simulation system using computerized three-dimensional graphics and dipole tracking. Neurosurgery 37:694703, 1995 Hayashi N, Endo S, Kurimoto M, et al: Functional image-guided neurosurgical simulation system using computerized three-dimensional graphics and dipole tracking. Neurosurgery 37:694–703, 1995

    • Search Google Scholar
    • Export Citation
  • 19.

    Iwasaki S, , Nakagawa H, & Fukisumi A: Identification of pre- and post-central gyri on CT and MR images on the basis of the medullary pattern of cerebral white matter. Radiology 179:207213, 1991 Iwasaki S, Nakagawa H, Fukisumi A: Identification of pre- and post-central gyri on CT and MR images on the basis of the medullary pattern of cerebral white matter. Radiology 179:207–213, 1991

    • Search Google Scholar
    • Export Citation
  • 20.

    Jack CR Jr, , Thompson RM, & Butts RK, et al: Sensory motor cortex: correlation of presurgical mapping with functional MR imaging and invasive cortical mapping. Radiology 190:8592, 1994 Jack CR Jr, Thompson RM, Butts RK, et al: Sensory motor cortex: correlation of presurgical mapping with functional MR imaging and invasive cortical mapping. Radiology 190:85–92, 1994

    • Search Google Scholar
    • Export Citation
  • 21.

    Kim SG, , Ashe J, & Georgopoulos AP, et al: Functional imaging of human motor cortex at high magnetic field. J Neurophysiol 69:297302, 1993 Kim SG, Ashe J, Georgopoulos AP, et al: Functional imaging of human motor cortex at high magnetic field. J Neurophysiol 69:297–302, 1993

    • Search Google Scholar
    • Export Citation
  • 22.

    Latchaw RE, , Hu X, & Ugurbil K, et al: Functional magnetic resonance imaging as a management tool for cerebral arteriovenous malformations. Neurosurgery 37:619626, 1995 Latchaw RE, Hu X, Ugurbil K, et al: Functional magnetic resonance imaging as a management tool for cerebral arteriovenous malformations. Neurosurgery 37:619–626, 1995

    • Search Google Scholar
    • Export Citation
  • 23.

    Levivier M, , Goldman S, & Pirotte B, et al: Diagnostic yield of stereotactic brain biopsy guided by positron emission tomography with [18F] fluorodeoxyglucose. J Neurosurg 82:445452, 1995 Levivier M, Goldman S, Pirotte B, et al: Diagnostic yield of stereotactic brain biopsy guided by positron emission tomography with [18F] fluorodeoxyglucose. J Neurosurg 82:445–452, 1995

    • Search Google Scholar
    • Export Citation
  • 24.

    Maciunas RL (ed): Interactive Image-Guided Neurosurgery. Chicago: American Association of Neurological Surgeons, 1993 Maciunas RL (ed): Interactive Image-Guided Neurosurgery. Chicago: American Association of Neurological Surgeons, 1993

    • Search Google Scholar
    • Export Citation
  • 25.

    Maldjian J, , Atlas SW, & Howard RS II, et al: Functional magnetic resonance imaging of regional brain activity in patients with intracerebral arteriovenous malformations before surgical or endovascular therapy. J Neurosurg 84:477483, 1996 Maldjian J, Atlas SW, Howard RS II, et al: Functional magnetic resonance imaging of regional brain activity in patients with intracerebral arteriovenous malformations before surgical or endovascular therapy. J Neurosurg 84:477–483, 1996

    • Search Google Scholar
    • Export Citation
  • 26.

    Maldjian JA, , Schulder M, & Liu WC, et al: Intraoperative functional MRI using a real-time neurosurgical navigation system. J Comput Assist Tomogr 21:910912, 1997 Maldjian JA, Schulder M, Liu WC, et al: Intraoperative functional MRI using a real-time neurosurgical navigation system. J Comput Assist Tomogr 21:910–912, 1997

    • Search Google Scholar
    • Export Citation
  • 27.

    Nakajima S, , Atsumi H, & Kikinis R, et al: Use of cortical surface vessel registration for image-guided neurosurgery. Neurosurgery 40:12011210, 1997 Nakajima S, Atsumi H, Kikinis R, et al: Use of cortical surface vessel registration for image-guided neurosurgery. Neurosurgery 40:1201–1210, 1997

    • Search Google Scholar
    • Export Citation
  • 28.

    Ogawa S, , Lee TM, & Kay AR: Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci USA 87:98689872, 1990 Ogawa S, Lee TM, Kay AR: Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci USA 87:9868–9872, 1990

    • Search Google Scholar
    • Export Citation
  • 29.

    Penfield W, & Boldrey E: Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 60:389443, 1937 Penfield W, Boldrey E: Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 60:389–443, 1937

    • Search Google Scholar
    • Export Citation
  • 30.

    Rezai AR, , Hund M, & Kronberg E, et al: The interactive use of magnetoencephalography in stereotactic image-guided neurosurgery. Neurosurgery 39:92102, 1996 Rezai AR, Hund M, Kronberg E, et al: The interactive use of magnetoencephalography in stereotactic image-guided neurosurgery. Neurosurgery 39:92–102, 1996

    • Search Google Scholar
    • Export Citation
  • 31.

    Roberts TP, & Rowley HA: Magnetic source imaging as a tool for presurgical functional brain mapping. Neurosurg Clin North Am 8:421438, 1997 Roberts TP, Rowley HA: Magnetic source imaging as a tool for presurgical functional brain mapping. Neurosurg Clin North Am 8:421–438, 1997

    • Search Google Scholar
    • Export Citation
  • 32.

    Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:2239, 1957 Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22–39, 1957

    • Search Google Scholar
    • Export Citation
  • 33.

    Smith KR, , Frank KJ, & Bucholz RD: The NeuroStation—a highly accurate, minimally invasive solution to frameless stereotactic neurosurgery. Comput Med Imaging Graph 18:247256, 1994 Smith KR, Frank KJ, Bucholz RD: The NeuroStation—a highly accurate, minimally invasive solution to frameless stereotactic neurosurgery. Comput Med Imaging Graph 18:247–256, 1994

    • Search Google Scholar
    • Export Citation
  • 34.

    Wood CC, , Spencer DD, & Allison T, et al: Localization of human sensorimotor cortex during surgery by cortical surface recording of somatosensory evoked potentials. J Neurosurg 68:99111, 1988 Wood CC, Spencer DD, Allison T, et al: Localization of human sensorimotor cortex during surgery by cortical surface recording of somatosensory evoked potentials. J Neurosurg 68:99–111, 1988

    • Search Google Scholar
    • Export Citation
  • 35.

    Yousry TA, , Schmid UD, & Jassoy AG, et al: Topography of the cortical motor hand area: prospective study with functional MR imaging and direct motor mapping at surgery. Radiology 195:2329, 1995 Yousry TA, Schmid UD, Jassoy AG, et al: Topography of the cortical motor hand area: prospective study with functional MR imaging and direct motor mapping at surgery. Radiology 195:23–29, 1995

    • Search Google Scholar
    • Export Citation

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