Functional neuronavigation with magnetoencephalography: outcome in 50 patients with lesions around the motor cortex

Ganslandt, Oliver; Fahlbusch, Rudolf; Nimsky, Christopher; Kober, H.; Möller, Martin; Steinmeier, Ralf; Romstöck, J.; Vieth, J.

doi:10.3171/jns.1999.91.1.0073

Cited by 206 publications

(77 citation statements)

References 27 publications

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“…The attempt to obtain clear waveforms was futile even after the electrode was shifted in an anterior-posterior or medial-lateral direction or after it was rotated by angles of 15 and 30 degrees. Feasibility of functional neuronavigation with MSI and electrical motor cortex stimulation During 80 operations both the SEP phase reversal and functional neuronavigation with MSI of the sensory and motor dipoles were performed (in part results from a subgroup of 50 patients published previously 10 ). In all patients magnetoencephalographic localisation of the sensory and motor gyri was correct.…”

Section: Feasibility Of Sep Phase Reversalmentioning

confidence: 99%

Localisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somatosensory evoked potentials

Romstöck

Fahlbusch

Ganslandt

et al. 2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

118

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Objective: Intraoperative localisation of the sensorimotor cortex using the phase reversal of somatosensory evoked potentials (SEPs) is an essential tool for surgery in and around the perirolandic gyri, but unsuccessful and perplexing results have been reported. This study examines the effect of tumour masses on the waveform characteristics and feasibility of SEP compared with functional neuronavigation and electrical motor cortex mapping. Methods: In 230 patients with tumours of the sensorimotor region the SEP phase reversal of N20-P20 was recorded from the exposed cortex using a subdural grid or strip electrode. In one subgroup of 80 patients functional neuronavigation was performed with motor and sensory magnetic source imaging and in one subgroup of 40 patients the motor cortex hand area was localised by electrical stimulation mapping. Results: The intraoperative SEP method was successful in 92% of all patients, it could be shown that the success rate rather depended on the location of the lesion than on preoperative neurological deficits. In 13% of the patients with postcentral tumours no N20-P20 phase reversal was recorded but characteristic polyphasic and high amplitude waves at 25 ms and later made the identification of the postcentral gyrus possible nevertheless. Electrical mapping of the motor cortex took up to 30 minutes until a clear result was obtained. It was successful in 37 patients, but failed in three patients with precentral and central lesions. Functional neuronavigation indicating the tumour margins and the motor and sensory evoked fields was possible in all patients. Conclusion: The SEP phase reversal of N20-P20 is a simple and reliable technique, but the success rate is much lower in large central and postcentral tumours. With the use of polyphasic late waveforms the sensorimotor cortex may be localised. By contrast with motor electrical mapping it is less time consuming. Functional neuronavigation is a desirable tool for both preoperative surgical planning and intraoperative use during surgery on perirolandic tumours, but compensation for brain shift, accuracy, and cost effectiveness are still a matter for discussion.

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Section: Feasibility Of Sep Phase Reversalmentioning

confidence: 99%

Localisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somatosensory evoked potentials

Romstöck

Fahlbusch

Ganslandt

et al. 2002

Journal of Neurology, Neurosurgery &Amp; Psychiatry

118

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“…Our unique concept for functional neuronavigationguided stereotactic procedure added two sets of data. The functional data from functional MR (fMR) imaging or magnetoencephalography (MEG) were integrated into the 3D MPRAGE navigational data set for functional neuronavigation, 7,11,19,20) which allowed correct alignment of the trajectory of the biopsy needle. In patients with diffuse lesions, the data from MR spectroscopy and positron emission tomography (PET) were also integrated into the anatomical 3D MPRAGE data set, which facilitated accurate target selection, resulting in improvement of diagnostic yield.…”

Section: Set Up Of the Operating Theatermentioning

confidence: 99%

Frameless Stereotactic Surgery Using Intraoperative High-Field Magnetic Resonance Imaging

Nimsky

Fujita

Ganslandt

et al. 2004

Neurol. Med. Chir.(Tokyo)

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This study evaluated the clinical validity of frameless stereotaxy using high-field intraoperative magnetic resonance (iMR) imaging combined with an in-room neuronavigation system. A 1.5 Tesla MR scanner in conjunction with a ceiling-mounted neuronavigation system was used during 32 frameless stereotaxy procedures consisting of 19 brain biopsies and 13 catheter placements between April 2002 and mid-October 2003. Evaluation of the procedure was based on either the rate of histological diagnostic yield or the ability to accurately position the catheter in the target region. This technique allowed successful registration with a mean error of 1.2 ± 0.8 mm and resulted in successful placement of the instrument within the target tissue. Intraoperatively, frozen section analysis showed all biopsy samples contained pathological tissue and locations of sampling points were confirmed by iMR imaging. Specific final diagnosis was made in all 19 brain biopsies. The tip of the catheter was successfully placed into the target in all 13 patients confirmed by iMR imaging. The catheter was repositioned based on iMR imaging in four of 13 patients, increasing the rate of successful placement. There were no procedure-related neurological deficits or mortality, but we encountered two cases of wound infection, one needing surgical revision. Total additional procedure time related to the induction of iMR imaging was 76.7 ± 23.3 minutes. This initial experience of the combination of conventional frameless stereotaxy and high-field iMR imaging improved the quality of frameless stereotaxy with low morbidity and mortality, but did not translate into a significant reduction of procedure-related time.

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“…In practice, it has been used to identify the sensorimotor, visual, and Wernicke's speech cortices [8,10,11,12]. Magnetic resonance (MR) axonography or anisotropic diffusion weighted MR imaging (ADWI) is a method that visualizes the axonal pathway in the brain.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, imaging modalities that enable the identification of functional brain areas have emerged as clinically significant [8][9][10][11][12][13][14][15][16][17][18]. Magnetoencephalography (MEG) is used AOYAMA H, et al, 5 to detect the magnetic field associated with intracranial neuronal electric activity itself.…”

Section: Introductionmentioning

confidence: 99%

“…The MEG studies were performed in a magnetically shielded room with a 204-channel wholehead biomagnetometer (VectorView; 4D-Neuroimage, San Diego, CA). The spatial resolution of MEG to detect the location of functional cortex is considered to be less than 5 mm [8][9][10][11][12] For the identification of the sensorimotor cortex in 15 patients, a somatosensory mapping protocol was used in which the median and tibial nerves contralateral to the side of the lesion were stimulated at the wrist and ankles, respectively, with 0.2 msec constant-current pulses. For the primary visual cortex mapping in 4 patients (Figure 1), the visually evoked field was measured by standard AOYAMA H, et al, 7 pattern shift stimulation.…”

Section: Introductionmentioning

confidence: 99%

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Integration of functional brain information into stereotactic irradiation treatment planning using magnetoencephalography and magnetic resonance axonography

Aoyama

Kamada

Shirato

et al. 2004

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To minimize the risk of neurological deficit following stereotactic irradiation, functional brain information was integrated into treatment planning.Materials and Methods: Twenty-one magnetoencephalography and 6 magnetic resonance axonographic images were made in 20 patients in order to evaluate the sensorimotor cortex (n=15 patients, including the corticospinal tract in 6), the visual cortex (n=4) and the Wernicke's area (n=2). One radiation oncologist was asked to formulate a treatment plan without the functional images at first, and then to modify the plan after seeing them. The pre-and post-modification values were compared for the volume of the functional area receiving 15 Gy or more (V15), and the volume of the PTV receiving more than 80% of the prescribed dose (V80-PTV).Results: Fifteen out of 21 plans (71%) were modified after seeing the functional images.After modification, V15 was significantly reduced compared to the values of pre-modification in those 15 sets of plans (p=0.03), whereas there was no significant difference in V80-PTV (p=0.99). During follow-up, a radiation-induced necrosis at the corticospinal tract caused minor motor deficit in one patient for whom MR-axonography was not available in the treatment planning. No other radiation-induced functional deficit was observed in the other patients. AOYAMA H, et al.,3 Conclusions: Integration of MEG and MR-axonography in treatment planning has the potential to reduce the risk of radiation-induced functional dysfunction without deterioration of the dose distribution in the target volume.

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Functional neuronavigation with magnetoencephalography: outcome in 50 patients with lesions around the motor cortex

Abstract: The method of incorporating functional data into neuronavigation systems is a promising tool that can be used in more radical surgery to lessen morbidity around eloquent brain areas.

Cited by 206 publications

References 27 publications

Localisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somatosensory evoked potentials

Localisation of the sensorimotor cortex during surgery for brain tumours: feasibility and waveform patterns of somatosensory evoked potentials

Frameless Stereotactic Surgery Using Intraoperative High-Field Magnetic Resonance Imaging

Integration of functional brain information into stereotactic irradiation treatment planning using magnetoencephalography and magnetic resonance axonography

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