title: Impact of preoperative functional magnetic resonance imaging during awake craniotomy procedures for intraoperative guidance and complication avoidance.
abstract: BACKGROUND
  We wanted to study the role of functional MRI (fMRI) in preventing neurological injury in awake craniotomy patients as this has not been previously studied.
  
  
  OBJECTIVE
  To examine the role of fMRI as an intraoperative adjunct during awake craniotomy procedures.
  
  
  METHODS
  Preoperative fMRI was carried out routinely in 214 patients undergoing awake craniotomy with direct cortical stimulation (DCS).
  
  
  RESULTS
  In 40% of our cases (n = 85) fMRI was utilized for the intraoperative localization of the eloquent cortex. In the other 129 cases significant noise distortion, poor task performance and nonspecific BOLD activation precluded the surgeon from using the fMRI data. Compared with DCS, fMRI had a sensitivity and specificity, respectively, of 91 and 64% in Broca's area, 93 and 18% in Wernicke's area and 100 and 100% in motor areas. A new intraoperative neurological deficit during subcortical dissection was predictive of a worsened deficit following surgery (p < 0.001). The use of fMRI for intraoperative localization was, however, not significant in preventing worsened neurological deficits, both in the immediate postoperative period (p = 1.00) and at the 3-month follow-up (p = 0.42).
  
  
  CONCLUSIONS
  The routine use of fMRI was not useful in identifying language sites as performed and, more importantly, practiced tasks failed to prevent neurological deficits following awake craniotomy procedures.
authors.affiliation: Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Tex., USA.
authors.forename: Victoria T
authors.initials: VT
authors.lastname: Trinh
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Fahim
authors.forename: Marcos V C
authors.initials: MV
authors.lastname: Maldaun
authors.forename: Komal
authors.initials: K
authors.lastname: Shah
authors.forename: Ian E
authors.initials: IE
authors.lastname: McCutcheon
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rao
authors.forename: Frederick
authors.initials: F
authors.lastname: Lang
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Weinberg
authors.forename: Raymond
authors.initials: R
authors.lastname: Sawaya
authors.forename: Dima
authors.initials: D
authors.lastname: Suki
authors.forename: Sujit S
authors.initials: SS
authors.lastname: Prabhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods*; D004558:Electric Stimulation; D005260:Female; D005910:Glioma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D057234:Preoperative Period; D014851:Wakefulness / Q000502:physiology*; D055815:Young Adult