Neuronavigation and Functional MRI for Surgery in Patients with Lesion in Eloquent Brain Areas

Gumprecht, Hartmut; Ebel, G.; Auer, Dorothee P.; Cb, Lumenta

doi:10.1055/s-2002-34341

Cited by 39 publications

(16 citation statements)

References 17 publications

(19 reference statements)

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“…However, valid clinical fMRI localizations need to be possible with every local hardware situation, and due to considerable mislocalizations in some of our patients, we conclude that automatic coregistration techniques should be evaluated carefully, especially in case of clinical application. With no doubt, such software may be useful during the preparation of clinical or non-clinical reports, but detailed control by experienced clinical fMRI professionals seems recommendable [1,2,36,37,[47][48][49]. Future research should extend evaluations of coregistration Maximum 3D distances between the reference point localizations generated by human experts are shown on the left for all 20 participants.…”

Section: Discussionmentioning

confidence: 99%

“…Comparable to related studies [10,11,[24][25][26][31][32][33][34][35][36][37], two groups of ten participants each were recruited for this investigation. Healthy right-handed volunteers (three females and seven males; mean age: 23.9 years; standard deviation: 4.3 years) and right-handed patients (six females and four males; mean age: 41.0 years; standard deviation: 16.3 years) suffering from large brain lesions.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of fMRI coregistration results between human experts and software solutions in patients and healthy subjects

et al. 2006

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Functional magnetic resonance imaging (fMRI) performed by echo-planar imaging (EPI) is often highly distorted, and it is therefore necessary to coregister the functional to undistorted anatomical images, especially for clinical applications. This pilot study provides an evaluation of human and automatic coregistration results in the human motor cortex of normal and pathological brains. Ten healthy right-handed subjects and ten right-handed patients performed simple right hand movements during fMRI. A reference point chosen at a characteristic anatomical location within the fMRI sensorimotor activations was transferred to the high resolution anatomical MRI images by three human fMRI experts and by three automatic coregistration programs. The 3D distance between the median localizations of experts and programs was calculated and compared between patients and healthy subjects. Results show that fMRI localization on anatomical images was better with the experts than software in 70% of the cases and that software performance was worse for patients than healthy subjects (unpaired t-test: P = 0.040). With 45.6 mm the maximum disagreement between experts and software was quite large. The inter-rater consistency was better for the fMRI experts compared to the coregistration programs (ANOVA: P = 0.003). We conclude that results of automatic coregistration should be evaluated carefully, especially in case of clinical application.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Comparison of fMRI coregistration results between human experts and software solutions in patients and healthy subjects

et al. 2006

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“…However, modern fusion techniques have only recently been developed. Therefore, there are little data in current literature which specifically analyzes and stratifies the clinical benefit of neuronavigation enhanced by fMRI [3,[23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

The impact of fMRI on multimodal navigation in surgery of cerebral lesions: four years clinical experience

2008

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Object Neuronavigation with display of intraoperative structures, instrument locations, orientation and relationships to nearby structures can increase anatomic precision while enhancing the surgeon's confidence and his/her perception of safety. Combination of neuronavigation with functional imaging provides multimodal guidance for surgery of cerebral lesions. We evaluated the impact of functional MRI (fMRI) on surgical decision making and outcome. Materials and methods A neuronavigational device (StealthStation (tm), Medtronic Inc.) was used as platform to merge fMRI data with anatomic images, and to implement intraoperative multimodal guidance. In a 52-month period, where 977 surgical procedures were performed with the aid of neuronavigation, 88 patients underwent image-guided procedures using multimodal guidance. Patient, surgical and outcome data of this series was prospectively collected. Results Evaluation of 88 procedures on cerebral lesions in complex regions where fMRI data were integrated using the navigation system demonstrated that the additional informa- G. Wurm (B) tion was presented in a user-friendly way. Computer assisted fMRI integration was found to be especially helpful in planning the best approach, in assessing alternative approaches, and in defining the extent of the surgical exposure. Furthermore, the surgeons found it more effective to interpret fMRI information when shown in a navigation system as compared to the traditional display on a light board or monitor. Conclusion Multimodal navigation enhanced by fMRI was judged useful for optimization of surgery of cerebral lesions, especially in and around eloquent regions by experienced neurosurgeons.

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“…The need for definition of eloquent cortex in the individual patient led to the clinical application of BOLD imaging, which is a noninvasive method increasingly used for the presurgical evaluation. Benson et al (2) compared the laterality of language dominance determined by BOLD with those determined by Wada testing In the present study, preoperative brain mapping with BOLD individually showed the anatomical relationship of somatosensory areas to tumour in vivo, optimized operative plan and guided surgical approach in 5 patients, although we were unable to integrate these functional images into surgical navigation system which had been described in recent literatures (9,30,33).…”

Section: The Value Of Preoperative Bold In Surgical Treatment Of Braimentioning

confidence: 58%

Preoperative assessment using multimodal functional magnetic resonance imaging techniques in patients with brain gliomas

Shang

Zhao²,

Zhang³

2011

Turkish Neurosurgery

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AIm:To evaluate the value of magnetic resonance spectroscopy (MRS), blood oxygen level-dependent imaging (BOLD) and diffusion tensor imaging (DTI) for preoperative assessment in patients with brain gliomas. mATeRIAL and meTHods: Twenty-three consecutive glioma patients underwent MRS, BOLD and DTI before operation. The characteristics of images were analysed according to histopathological results. ResuLTs:There is significant elevation of the choline (Cho) /creatine (Cr) ratio, Cho peak and depression of the N-acetylaspartate (NAA) peak in gliomas. Elevation of the Cho/Cr, Cho/NAA ratio and the presence of a lipids peak, were consistent with high-grade malignancy. A motor activation scan was achieved by using a motor task paradigm in 20 patients. Deformation and displacement of the motor activations was found in 5 cases. The margin of tumor and peritumoural white matter tracts were identified using apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps. Three patterns of white matter tracts alteration were identified: displacement, infiltration, and disruption. In all 23 patients, the tumors were completely resected in 6 patients, subtotal resected in 8 patients, partial resected in 9 patients. No secondary neurological deficit was occurred in all patients after operation. CoNCLusIoN:The combination of MRS, BOLD, and DTI techniques allows appropriate presurgical planning of brain gliomas.KeywoRds: Glioma, Operation, Functional magnetic resonance imaging ÖZ AmAÇ: Beyin gliomlu hastalarda preoperatif değerlendirme için manyetik rezonans spektroskopisi (MRS), kan oksijen seviyesine bağımlı görüntüleme (BOLD) ve difüzyon tensor görüntülemenin (DTI) önemini değerlendirmek. yÖNTem ve GeReÇLeR: Arka arkaya 23 gliom hastasında ameliyat öncesinde MRS, BOLD ve DTI yapıldı. Görüntülerin özellikleri histopatolojik sonuçlara göre değerlendirildi.BuLGuLAR: Gliomlarda kolin (Cho) /kreatin (Cr) oranı ve Cho tepe değerinde önemli artış varken N-asetilaspartat (NAA) tepe değerinde azalma görülür. Cho/Cr ve Cho/NAA oranı artışı ve bir lipid tepe değerinin varlığı yüksek dereceli malignansi ile tutarlıydı. Bir motor görev paradigması kullanılarak 20 hastada bir motor aktivasyon taraması yapıldı. Beş vakada motor aktivasyonlarda deformasyon ve displasman bulundu. Peritümöral beyaz madde kanalları ve tümör kenarı görünür difüzyon katsayısı (ADC) ve fraksiyonel anisotropi (FA) haritaları kullanılarak tanımlandı. Üç beyaz madde kanalı değişme paterni tanımlandı: displasman, infiltrasyon ve bozulma. Bu 23 hasta içinde 6 hastada tamamen tümör rezeksiyonu yapıldı, 8 hastada subtotal rezeksiyon yapıldı ve 9 hastada kısmi rezeksiyon yapıldı. Ameliyattan sonra hiçbir hastada ikincil nörolojik defisit görülmedi. soNuÇ: MRS, BOLD ve DTI tekniklerinin kombinasyonu beyin gliomlarında cerrahi öncesi uygun planlamayı mümkün kılar.

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Neuronavigation and Functional MRI for Surgery in Patients with Lesion in Eloquent Brain Areas

Cited by 39 publications

References 17 publications

Comparison of fMRI coregistration results between human experts and software solutions in patients and healthy subjects

Comparison of fMRI coregistration results between human experts and software solutions in patients and healthy subjects

The impact of fMRI on multimodal navigation in surgery of cerebral lesions: four years clinical experience

Preoperative assessment using multimodal functional magnetic resonance imaging techniques in patients with brain gliomas

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