Functional magnetic resonance imaging and diffusion tensor tractography incorporated into an intraoperative 3-dimensional ultrasound-based neuronavigation system: impact on therapeutic strategies, extent of resection, and clinical outcome.

Abstract:

BACKGROUND:Functional neuronavigation with intraoperative 3-dimensional (3D) ultrasound may facilitate safer brain lesion resections than conventional neuronavigation. OBJECTIVE:In this study, functional magnetic resonance imaging (fMRI) and diffusion tensor tractography (DTT) were used to map eloquent areas. We assessed the use of fMRI and DTT for preoperative assessments and determined whether using these data together with 3D ultrasound during surgery enabled safer lesion resection. METHODS:We reviewed 51 consecutive patients with intracranial lesions in whom fMRI with or without DTT was used to map eloquent areas. To assess a possible impact of fMRI/DTT, we reviewed and analyzed the quality of the fMRI/DTT data, any change in therapeutic strategies, lesion to eloquent area distance (LEAD), extent of resection, and clinical outcome. RESULTS:As a result of the fMRI/DTT mapping, the therapeutic strategies were changed in 4 patients. The median tumor residue for glioma patients was 11% (n = 33) and 0% for nonglioma lesions (n = 12). For gliomas, there was a significant correlation between decreasing LEAD and increasing tumor residue. Of the glioma patients, 42% underwent gross total resection (>or= 95%) and 12% suffered neurological worsening after surgery as a result of complications. Of glioma patients with an LEAD of

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Berntsen EM,Gulati S,Solheim O,Kvistad KA,Torp SH,Selbekk T,Unsgård G,Håberg AK

doi

10.1227/01.NEU.0000371731.20246.AC

subject

Has Abstract

pub_date

2010-08-01 00:00:00

pages

251-64

issue

2

eissn

0148-396X

issn

1524-4040

pii

00006123-201008000-00013

journal_volume

67

pub_type

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