title: Functional magnetic resonance imaging of the visual cortex performed in children under sedation to assist in presurgical planning.
abstract: OBJECTIVE
  Advances in brain imaging have allowed for more sophisticated mapping of crucial neural structures. Functional MRI (fMRI) measures local changes in blood oxygenation associated with changes in neural activity and is useful in mapping cortical activation. Applications of this imaging modality have generally been restricted to cooperative patients; however, fMRI has proven successful in localizing the motor cortex for neurosurgical planning in uncooperative children under sedation. The authors demonstrate that the use of fMRI to localize the visual cortex in sedated children can be safely and effectively performed, allowing for more accurate presurgical planning to spare visual structures.
  
  
  METHODS
  Between 2007 and 2009, 11 children (age range 1-11 years) underwent fMRI for neurosurgical planning while under sedation. Blood oxygen level-dependent fMRI was performed to detect visual cortex activation during stimulation through closed eyelids. Visual stimulation was presented in block design with periods of flashing light alternated with darkness.
  
  
  RESULTS
  Functional MRI was successful in identifying visual cortex in each of the 11 children tested. There were no complications with propofol sedation or the fMRI. All children suffered from epilepsy, 5 had brain tumors, and 1 had tuberous sclerosis. After fMRI was performed, 6 patients underwent surgery. Frameless stereotactic guidance was synchronized with fMRI data to design an approach to spare visual structures during resection. There were no cases where a false negative led to unexpected visual field deficits or other side effects of surgery. In 2 cases, the fMRI results demonstrated that the tracts were already disrupted: in one case from a prior tumor operation and in another from dysplasia.
  
  
  CONCLUSIONS
  Functional MRI for evaluation of visual pathways can be safely and reproducibly performed in young or uncooperative children under light sedation. Identification of primary visual cortex aids in presurgical planning to avoid vision loss in appropriately selected patients.
authors.affiliation: University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Weier
authors.initials: W
authors.lastname: Li
authors.forename: Scott D
authors.initials: SD
authors.lastname: Wait
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ogg
authors.forename: Matt A
authors.initials: MA
authors.lastname: Scoggins
authors.forename: Ping
authors.initials: P
authors.lastname: Zou
authors.forename: James
authors.initials: J
authors.lastname: Wheless
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Boop
mesh_terms: D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001931:Brain Mapping / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D021621:Imaging, Three-Dimensional; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009044:Motor Cortex / Q000473:pathology / Q000503:physiopathology; D019635:Neurosurgical Procedures; D011300:Preoperative Care / Q000379:methods*; D015742:Propofol / Q000008:administration & dosage; D012640:Seizures / Q000209:etiology / Q000503:physiopathology; D014402:Tuberous Sclerosis / Q000150:complications / Q000503:physiopathology; D014793:Visual Cortex / Q000473:pathology / Q000503:physiopathology
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D015742:Propofol