Functional magnetic resonance-guided brain tumor resection

Functional magnetic resonance imaging (fMRI) allows for the delineation of cortical areas involved in critical neurologic function such as language, motor movement, memory, and other cognitive functions. When used in concert with frameless neuronavigation or intraoperative MRI (ioMRI), this information can provide the clinician with near real-time feedback, enabling the neurosurgeon to distinguish between areas of neoplasia and non-eloquent or eloquent brain tissue. We review our experience of combining preoperative fMRI data obtained at both 1.5 and 3 Tesla (T) with ioMRI-guided tumor resection at 1.5 T. We briefiy describe the MRI operating suite, those protocols used for ioMRI-guided surgery, and we also review the experience of others performing fMRI to aid in neurosurgery utilizing neuronavigation. In our two series, patients underwent preoperative fMRI to identify areas in the brain for motor or language activation or both. Tumors that were deemed resectable underwent an attempted gross total resection with ioMRI guidance at 1.5 T. There were no permanent neurologic deficits seen in any patient in these series. fMRI is a useful tool for neuronavigation in tumor surgery that allows for an aggressive pursuit of gross total resection, even for tumors adjacent to eloquent cortex. fMRI has been used successfully in concert with frameless neuronavigation, ioMRI, and direct surgical methods such as awake craniotomy and intraoperative cortical stimulation. We have found that the combination of preoperative fMRI with ioMRI-guided brain tumor resection at 1.5 T has yielded excellent clinical results. Introduction: Functional magnetic resonance imaging (fMRI) allows for the delineation of cortical areas involved in critical neurologic function such as language, motor movement, memory, and other cognitive functions. When used in concert with frameless neuronavigation or intraoperative MRI (ioMRI), this information can provide the clinician with near real-time feedback, enabling the neurosurgeon to distinguish between areas of neoplasia and non-eloquent or eloquent brain tissue. Methods: We review our experience of combining preoperative fMRI data obtained at both 1.5 and 3 Tesla (T) with ioMRI-guided tumor resection at 1.5 T. We briefly describe the MRI operating suite, those protocols used for ioMRI-guided surgery, and we also review the experience of others performing fMRI to aid in neurosurgery utilizing neuronavigation. Results: In our two series, patients underwent preoperative fMRI to identify areas in the brain for motor or language activation or both. Tumors that were deemed resectable underwent an attempted gross total resection with ioMRI guidance at 1.5 T. There were no permanent neurologic deficits seen in any patient in these series. Conclusions: fMRI is a useful tool for neuronavigation in tumor surgery that allows for an aggressive pursuit of gross total resection, even for tumors adjacent to eloquent cortex. fMRI has been used successfully in concert with frameless neuronavigation, ioMRI, and direct surgical methods such as awake craniotomy and intraoperative cortical stimulation. We have found that the combination of preoperative fMRI with ioMRI-guided brain tumor resection at 1.5 T has yielded excellent clinical results.