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Free keywords:
fMRI; Neuronavigation; Glioma; Meningeoma; Metastases
Abstract:
Background and Purpose:
Localization of primary sensorimotor cortex is an important radiologic tool when approaching lesions involving eloquent regions. The clinical impact and efficacy of functional magnetic resonance imaging (fMRI) in image-guided surgery of tumors in the central region will be analyzed.
Patients and Methods:
104 patients were operated, 49 patients using fMRI and neuronavigation (group 1), and 55 patients using anatomic landmarks (group 2). In group 1 image fusion of functional and anatomic image data was performed automatically and manually by a special fusion software using anatomic landmarks and skin fiducials just before surgery (STP 4.0, Carl Zeiss, Oberkochen, Germany). In both groups tumor resection was done microsurgically and, as far as possible, completely. The comparison between both groups was based on their pre- and postoperative neurologic status as well as on the tumor entities: gliomas, meningeomas, and metastases.
Results:
The group that benefited most clearly, but not significantly from the use of fMRI and neuronavigation was that of patients with gliomas (p > 0.05). Here, the percentage of postoperative deteriorations could be reduced from 40% to 23%. The group of patients with metastases profited slightly from the use of fMRI and neuronavigation. The percentage of all patients with an identical and better surgery-associated neurology increased from 79% to 89%. In the meningeoma group the number of patients with an identical and improved neurologic postoperative outcome was identical in both groups (89%).
Conclusion:
The greatest benefit of fMRI could be demonstrated in the treatment of gliomas. FMRI and neuronavigation can unreservedly be recommended for resection of centrally located gliomas. Otherwise, the use of fMRI and neuronavigation is a supplementary diagnostic and intraoperative measure to increase the patient’s and surgeon’s safety. Identification of functional eloquent regions is important in assessing the operative risk and in determining the optimal operative approach to the neurosurgically relevant lesion.
