The effect of brain tumors on BOLD functional MR imaging activation in the adjacent motor cortex: implications for image-guided neurosurgery.

BACKGROUND AND PURPOSE Functional MR (fMR) imaging data coregistered to a neurosurgical navigation system have been proposed as guides for the resection of brain tumor in or adjacent to eloquent cortices. The purpose of this study was to compare data obtained from the side of the brain affected by tumor with the contralateral side and to determine if there are physiological limitations of fMR imaging in accurately determining the location of the primary motor cortex. METHODS Ten patients with tumors in or directly adjacent to the motor cortex were studied with fMR imaging (finger-tapping paradigm). fMR imaging data were analyzed using multiple R values. These data were coregistered to a real-time intraoperative neurosurgical navigation system. RESULTS Significant variability of motor cortex activation patterns was noted among individual patients. The activation volumes on the side of the tumor were significantly smaller compared with the contralateral side for all tumors not previously resected (0.66+/-0.47). This was most pronounced in glioblastomas (0.27+/-0.21). We propose that these differences were caused by a loss of autoregulation in the tumor vasculature of glioblastomas and venous effects. CONCLUSION Notwithstanding the differences noted, the motor cortex was identified successfully in all patients. This was confirmed by intraoperative physiological identification of the motor cortex and a lack of postoperative neurologic deficit.

[1]  R. Llinás,et al.  Somatosensory cortical plasticity in adult humans revealed by magnetoencephalography. , 1993, Proceedings of the National Academy of Sciences of the United States of America.

[2]  K Ugurbil,et al.  Functional magnetic resonance imaging as a management tool for cerebral arteriovenous malformations. , 1995, Neurosurgery.

[3]  G A Ojemann,et al.  Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors. , 1989, Neurosurgery.

[4]  E. Maclin,et al.  Noninvasive preoperative cortical localization by magnetic source imaging. , 1992, AJNR. American journal of neuroradiology.

[5]  M. D’Esposito,et al.  Functional magnetic resonance imaging of regional brain activity in patients with intracerebral gliomas: findings and implications for clinical management. , 1996, Neurosurgery.

[6]  Mitchel S. Berger,et al.  Brain Mapping Techniques to Maximize Resection, Safety, and Seizure Control in Children with Brain Tumors , 1989 .

[7]  J. Maldjian,et al.  Functional image-guided surgery of intracranial tumors located in or near the sensorimotor cortex. , 1998, Journal of neurosurgery.

[8]  S. Ogawa.  Brain magnetic resonance imaging with contrast-dependent oxygenation , 1990 .

[9]  V. Ramachandran,et al.  Perceptual correlates of massive cortical reorganization. , 1992, Neuroreport.

[10]  P T Fox,et al.  Quantitative assessment of blood inflow effects in functional MRI signals , 1996, Magnetic resonance in medicine.

[11]  J A Maldjian,et al.  Decreased BOLD functional MR activation of the motor and sensory cortices adjacent to a glioblastoma multiforme: implications for image-guided neurosurgery. , 1999, AJNR. American journal of neuroradiology.

[12]  R. Llinás,et al.  The interactive use of magnetoencephalography in stereotactic image-guided neurosurgery. , 1996, Neurosurgery.

[13]  M. Hallett,et al.  Plasticity of cortical motor output organization following deafferentation, cerebral lesions, and skill acquisition. , 1993, Advances in neurology.

[14]  A. Holodny,et al.  The use of hyperventilation in contrast-enhanced MR of brain tumors. , 1997, AJNR. American journal of neuroradiology.

[15]  E C Wong,et al.  Processing strategies for time‐course data sets in functional mri of the human brain , 1993, Magnetic resonance in medicine.

[16]  M. Mikhael,et al.  Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. , 1987, Neurosurgery.

[17]  R J Seitz,et al.  Large-scale plasticity of the human motor cortex. , 1995, Neuroreport.

[18]  J. Maldjian,et al.  Intraoperative functional MRI using a real-time neurosurgical navigation system. , 1997, Journal of computer assisted tomography.

[19]  C. Jack,et al.  Sensory motor cortex: correlation of presurgical mapping with functional MR imaging and invasive cortical mapping. , 1994, Radiology.

[20]  M. Khan,et al.  The recurrence of intracranial meningiomas after surgical treatment. , 1983, Journal of neurosurgery.

[21]  R P Woods,et al.  Functional MR and PET imaging of rolandic and visual cortices for neurosurgical planning. , 1995, Journal of neurosurgery.

[22]  P J Kelly,et al.  Resection, biopsy, and survival in malignant glial neoplasms. A retrospective study of clinical parameters, therapy, and outcome. , 1993, Journal of neurosurgery.

[23]  D. Tank,et al.  Brain magnetic resonance imaging with contrast dependent on blood oxygenation. , 1990, Proceedings of the National Academy of Sciences of the United States of America.

[24]  F. Bloom,et al.  Locating the central sulcus: comparison of MR anatomic and magnetoencephalographic functional methods. , 1993, AJNR. American journal of neuroradiology.

[25]  R. Bucholz.  The central sulcus and surgical planning. , 1993, AJNR. American journal of neuroradiology.

[26]  G A Ojemann,et al.  Individual variability in cortical localization of language. , 1979, Journal of neurosurgery.

[27]  J. R. Baker,et al.  The intravascular contribution to fmri signal change: monte carlo modeling and diffusion‐weighted studies in vivo , 1995, Magnetic resonance in medicine.