title: [Intraoperative magnetic resonance imaging-guided functional neuronavigation plus intraoperative neurophysiological monitoring for microsurgical resection of lesions involving hand motor area].
abstract: OBJECTIVE
  To explore the methods and applications of intraoperative magnetic resonance imaging (iMRI)-guided functional neuronavigation plus intraoperative neurophysiological monitoring (IONM) for microsurgical resection of lesions involving hand motor area.
  
  
  METHODS
  A total of 16 patients with brain lesions adjacent to hand motor area were recruited from January 2011 to April 2012. All of them underwent neuronavigator-assisted microsurgery. Also IONM was conducted to further map hand motor area and epileptogenic focus. High-field iMRI was employed to update the anatomical and functional imaging date and verify the extent of lesion resection.
  
  
  RESULTS
  Brain shifting during the functional neuronavigation was corrected by iMRI in 5 patients. Finally, total lesion resection was achieved in 13 cases and subtotal resection in 3 cases. At Months 3-12 post-operation, hand motor function improved (n = 10) or remained unchanged (n = 6). None of them had persistent neurological deficit. The postoperative seizure improvement achieved Enge II level or above in 9 cases of brain lesions complicated with secondary epilepsy.
  
  
  CONCLUSIONS
  Intraoperative MRI, functional neuronavigation and neurophysiological monitoring technique are complementary in microsurgery of brain lesions involving hand motor area. Combined use of these techniques can obtain precise location of lesions and hand motor functional structures and allow a maximum resection of lesion and minimization of postoperative neurological deficits.
authors.affiliation: Department of Neurosurgery, General Hospital, Tianjin Medical University, Tianjin, China.
authors.forename: Xing-lu
authors.initials: XL
authors.lastname: Miao
authors.forename: Zhi-juan
authors.initials: ZJ
authors.lastname: Chen
authors.forename: Wei-dong
authors.initials: WD
authors.lastname: Yang
authors.forename: Zeng-guang
authors.initials: ZG
authors.lastname: Wang
authors.forename: Qing
authors.initials: Q
authors.lastname: Yu
authors.forename: Shu-yuan
authors.initials: SY
authors.lastname: Yue
authors.forename: Jian-ning
authors.initials: JN
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006225:Hand; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009044:Motor Cortex / Q000601:surgery*; D038361:Neuronavigation; D055815:Young Adult