Functional Magnetic Resonance Imaging Mapping of the Motor Cortex in Patients with Cerebral Tumors

The Role of Functional MRI in Intracranial Glioma Resection

“…Accurate knowledge of the anatomical relationship of a glioma with neighboring eloquent cortical areas is of paramount importance for maximizing tumor resection, minimizing the chance of postoperative neurological deficit, and thus maximizing the patient's safety. Functional MRI has been employed for more than 15 years in the preoperative evaluation of patients harboring intracranial gliomas for identifying, accurately localizing, and intraoperatively avoiding functional cortical centers [Atlas et al, 1996;Berntsen et al, 2010;Bizzi et al, 2008;Fandino et al, 1999;Fitzgerald et al, 1997;Giussani et al, 2010;Haberg et al, 2004;Hirsch et al, 2000;Hoenig et al, 2005;Krasnow et al, 2003;Krishnan et al, 2004;Lehericy et al, 2000;Li et al, 2010;Lurito et al, 2000;Mueller et al, 1996;National Comprehensive Cancer Network, 2007;Petrovich et al, 2005;Pouratian et al, 2002;Puce et al, 1995;Roux et al, Ruge et al, 1999;Rutten et al, 2002;Sanai & Berger, 2008;Schulder et al, 1998;Signorelli et al, 2003;Tieleman et al, 2007;Tomczak et al, 2000;Yetkin et al, 1997;Yousry et al, 1995] (Figures 1 & 2). Several clinical studies have been performed comparing fMRI with intraoperative electrophysiological stimulation studies, with varying results, and frequently contradictory conclusions [Atlas et al, 1996;Berntsen et al, 2010;Bizzi et al, 2008;Fandino et al, 1999;Fitzgerald et al, 1997;…”

“…Therefore, their results are not comparable, in the vast majority of cases. However, a systematic review of the existent clinical studies show that fMRI constitutes a routine clinical practice in many neuro-oncology centers around the world, which provides the opportunity to the performing neurosurgeon for a more realistic and accurate preoperative discussion with the patient, a wiser decision-making process, a safer surgical planning, and a more aggressive tumor resection [Atlas et al, 1996;Berntsen et al, 2010;Bizzi et al, 2008;Fandino et al, 1999;Fitzgerald et al, 1997;Giussani et al, 2010;Haberg et al, 2004;Hirsch et al, 2000;Hoenig et al, 2005;Krasnow et al, 2003;Krishnan et al, 2004;Lehericy et al, 2000;Li et al, 2010;Lurito et al, 2000;Mueller et al, 1996;National Comprehensive Cancer Network, 2007;Petrovich et al, 2005;Pouratian et al, 2002;Puce et al, 1995;Ruge et al, 1999;Roux et al, 2003;Rutten et al, 2002;Sanai & Berger, 2008;Schulder et al, 1998;Signorelli et al, 2003;Tieleman et al, 2007;Tomczak et al, 2000;Yetkin et al, 1997;Yousry et al, 1995]. Several studies also emphasize that fMRI can localize more accurately motor and sensory cortical areas than language areas, and therefore they indicate the necessity for employing complimentary intraoperative electrophysiological stimulation studies, in cases of tumor proximity to language-associated cortical areas [Berntsen et al, 2010;Giussani et al, 2010;Hirsch et al, 2000;Roux et al, 2003;…”

“…Their fMRI protocol included sponge squeezing as a motor task, and electrical stimulation of the median nerve, palm light brushing, and palm air blowing as sensory tasks [Puce et al, 1995]. Mueller et al [Mueller et al, 1996] reported 10 patients with intracranial tumors and 2 patients with intracranial vascular lesions undergoing preoperative fMRI at 1.5T for sensorimotor cortex localization, and intraoperative DCS. Their fMRI protocol included indexthumb tapping as a motor task, and palm light scratching as a sensory task [Mueller et al, 1996].…”

“…Mueller et al [Mueller et al, 1996] reported 10 patients with intracranial tumors and 2 patients with intracranial vascular lesions undergoing preoperative fMRI at 1.5T for sensorimotor cortex localization, and intraoperative DCS. Their fMRI protocol included indexthumb tapping as a motor task, and palm light scratching as a sensory task [Mueller et al, 1996]. They found that fMRI accuracy was 100% in their retrospective study [Mueller et al, 1996].…”

“…Their fMRI protocol included indexthumb tapping as a motor task, and palm light scratching as a sensory task [Mueller et al, 1996]. They found that fMRI accuracy was 100% in their retrospective study [Mueller et al, 1996]. They also reported that they had no postoperative motor deficits, when their resection distance was more than 5 mm from the fMRI identified motor cortex [Mueller et al, 1996].…”