Preoperative fMRI in tumour surgery

Abstract

Minimally invasive resection of brain tumours aims at removing as much pathological tissue as possible while preserving essential brain functions. Therefore, the precise spatial relationship between the lesion and adjacent functionally essential brain parenchyma needs to be known. Functional magnetic resonance imaging (fMRI) is increasingly being used for this purpose because of its non-invasiveness, its relatively high spatial resolution and the preoperative availability of the results. In this review, the goals of fMRI at various key points during the management of patients with a brain tumour are discussed. Further, several practical aspects associated with fMRI for motor and language functioning are summarised, and the validation of the fMRI results with standard invasive mapping techniques is addressed. Next, several important pitfalls and limitations that warrant careful interpretations of the fMRI results are highlighted. Finally, two important future perspectives of presurgical fMRI are emphasised.

Potential Impact of a 32-Channel Receiving Head Coil Technology on the Results of a Functional MRI Paradigm

“…These results provide a valuable benefit for fMRI studies performed for presurgical planning in patients with tumors, e.g., in the region adjacent to the motor cortex [37][38][39], which is a rather common clinical application of fMri. Furthermore, the potential of the coil to provide better Snr in areas near its surface could be especially useful in studies with event-related designs, which typically cope with extremely low Snrs [40].…”

Clinical Standardized fMRI Reveals Altered Language Lateralization in Patients with Brain Tumor

“…Furthermore it should be considered that presurgical language fMRI is an evolving, though not yet clinically established, imaging approach. 53 The primary aim of our study was to analyze a large number of patients with brain tumors to investigate language lateralization; therefore, we included all consecutive righthanded patients with left hemispheric brain tumors affecting the Broca and Wernicke areas, independent of the WHO grade. A cohort large enough to enable statistical comparisons between different entities of brain tumors would require a large multicenter trial.…”

Blood Oxygen Level Dependent Functional Magnetic Resonance Imaging for Presurgical Planning

“…2,23 PARESIS Paresis or weakness often occurs when the primary motor gyrus is injured or infiltrated by tumor or edema. 5 Paradigms for patients with paresis or weakness should be altered on a case-bycase basis. For example, sequential finger tapping can be modified to hand clenching for patients with partial hand paralysis.…”