title: Multimodal cranial neuronavigation: direct integration of functional magnetic resonance imaging and positron emission tomography data: technical note.
abstract: OBJECTIVE
  This is the first report of the direct integration of functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) data into cranial neuronavigation.
  
  
  METHODS
  In a patient with a left precentral oligodendroglioma (World Health Organization Grade III), the Zeiss MKM system (Carl Zeiss Co., Oberkochen, Germany) was used for navigation based on thin-slice, T1-weighted, contrast-enhanced magnetic resonance imaging (MRI) scans. fMRI and methionine PET data were integrated by landmark matching, with reference to skin fiducials.
  
  
  RESULTS
  The inaccuracy of the image fusion between fMRI and T1-weighted MRI data was 1.7 mm, that between PET and T1-weighted MRI data was 4.3 mm, and that for the subsequent registration of the navigation was 1.2 mm. The correct fMRI localization of the precentral gyrus was intraoperatively verified by cortical somatosensory evoked potential (phase-reversal) monitoring. Although the tumor was not clearly defined in the MRI scans, [11C]methionine PET demonstrated a clear tumor border, enabling us to achieve gross total tumor removal without postoperative functional deficits.
  
  
  CONCLUSIONS
  Functional neuronavigation permits observation and preservation of relevant brain areas. Other functional areas (such as short-term memory areas) that can be detected only by fMRI might also warrant future monitoring. The simultaneous integration of fMRI and PET data adds a new dimension to cranial neuronavigation, enabling the observation of tumors in relation to functional cortical areas (in our case, the motor strip).
authors.affiliation: Department of Neurosurgery, University of Ulm, Günzburg, Germany. veit.braun@medizin.uni-ulm.de
authors.forename: V
authors.initials: V
authors.lastname: Braun
authors.forename: S
authors.initials: S
authors.lastname: Dempf
authors.forename: R
authors.initials: R
authors.lastname: Tomczak
authors.forename: A
authors.initials: A
authors.lastname: Wunderlich
authors.forename: R
authors.initials: R
authors.lastname: Weller
authors.forename: H P
authors.initials: HP
authors.lastname: Richter
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D002250:Carbon Radioisotopes; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008715:Methionine; D009837:Oligodendroglioma / Q000175:diagnosis* / Q000601:surgery*; D011859:Radiography; D013813:Therapy, Computer-Assisted; D014055:Tomography, Emission-Computed
chemical_list: D002250:Carbon Radioisotopes; D008715:Methionine