Evaluation of preoperative high magnetic field motor functional MRI (3 Tesla) in glioma patients by navigated electrocortical stimulation and postoperative outcome.
OBJECTIVE
The validity of 3 Tesla motor functional magnetic resonance imaging (fMRI) in patients with gliomas involving the primary motor cortex was investigated by intraoperative navigated motor cortex stimulation (MCS).


METHODS
Twenty two patients (10 males, 12 females, mean age 39 years, range 10-65 years) underwent preoperative fMRI studies, performing motor tasks including hand, foot, and mouth movements. A recently developed high field clinical fMRI technique was used to generate pre-surgical maps of functional high risk areas defining a motor focus. Motor foci were tested for validity by intraoperative motor cortex stimulation (MCS) employing image fusion and neuronavigation. Clinical outcome was assessed using the Modified Rankin Scale.


RESULTS
FMRI motor foci were successfully detected in all patients preoperatively. In 17 of 22 patients (77.3%), a successful stimulation of the primary motor cortex was possible. All 17 correlated patients showed 100% agreement on MCS and fMRI motor focus within 10 mm. Technical problems during stimulation occurred in three patients (13.6%), no motor response was elicited in two (9.1%), and MCS induced seizures occurred in three (13.6%). Combined fMRI and MCS mapping results allowed large resections in 20 patients (91%) (gross total in nine (41%), subtotal in 11 (50%)) and biopsy in two patients (9%). Pathology revealed seven low grade and 15 high grade gliomas. Mild to moderate transient neurological deterioration occurred in six patients, and a severe hemiparesis in one. All patients recovered within 3 months (31.8% transient, 0% permanent morbidity).


CONCLUSIONS
The validation of clinically optimised high magnetic field motor fMRI confirms high reliability as a preoperative and intraoperative adjunct in glioma patients selected for surgery within or adjacent to the motor cortex.
Roessler
K
K
Department of Neurosurgery Medical University of Vienna, Vienna, Austria. karl.roessler@meduniwien.ac.at
Donat
M
M
Lanzenberger
R
R
Novak
K
K
Geissler
A
A
Gartus
A
A
Tahamtan
A R
AR
Milakara
D
D
Czech
T
T
Barth
M
M
Knosp
E
E
Beisteiner
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000295:instrumentation*; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D002648:Child; D004558:Electric Stimulation / Q000295:instrumentation*; D005260:Female; D005385:Fingers / Q000503:physiopathology*; D005910:Glioma / Q000150:complications / Q000473:pathology / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000473:pathology* / Q000503:physiopathology*; D009069:Movement Disorders / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D009367:Neoplasm Staging; D011184:Postoperative Period; D011300:Preoperative Care; D012720:Severity of Illness Index; D016896:Treatment Outcome