Clinical application of functional magnetic resonance imaging in presurgical identification of the central sulcus

Abstract

Although specific factors were identified that contributed to reduced sensitivity of fMR imaging in the clinical context, the present study supports functional assessment and 3-D representation of specific surgical situations as generally feasible in common practice.

Relationship between the coronal suture and the central lobe: how important is it and how can we use it in surgical planning?

“…so, although these measurements give the neurosurgeon an idea about the localization of the central sulcus, the use of other tools becomes necessary in the surgical planning. For such cases the use of functional magnetic resonance (fMrI) and/or electrophysiological studies [10][11][12][13][14] or awake craniotomy are recommended 15 . It is very important to remember that the central lobe must be manipulated carefully, avoiding excessive and unnecessary traction of the structures according to the principles of yasargil 16 .…”

Intraoperative validation of functional magnetic resonance imaging and cortical reorganization patterns in patients with brain tumors involving the primary motor cortex

“…The authors stated that "electrical stimulation of the motor nerve (SSEPs) was not an optimum stimulus and produced little activation in the controls;" nevertheless, a good correspondence of motor areas identified by fMR imaging and ECS was reported in all four patients. Pujol and associates [37] evaluated 50 consecutive surgical candidates with central lesions. In nine (18%) of 50 patients preoperative identification of the central sulcus was unsuccessful, and a subgroup of 22 patients underwent ECS for validation of fMR imaging findings; nevertheless, the authors reported confirmation of fMR imaging in 100% of the cases in which the tumor was used as a landmark for intraoperative identification of the sensorimotor cortex.…”

“…Early experiences with this technique in functional imaging of the human visual cortex [2,31] and sensorimotor cortex [21] have encouraged its application in patients with brain lesions, especially as a noninvasive preoperative study for surgical planning. [12,15,17,18,29,36,37,50] More recently, our group[23] reported the application of fMR imaging in 12 patients with retrochiasmatic lesions who had undergone surgical treatment. In this study, Kollias, et al, demonstrated that fMR imaging can detect visual field defects that are not only caused by lesions that destroy the primary visual cortex but also by lesions that interrupt the visual pathway, creating a lack of sensory input.…”

“…Detailed visualization of the brain structures in magnetic resonance (MR) imaging [29] has encouraged further applications of electrophysiological techniques to correlate anatomical and functional findings in the human cortex. [3,6] More recently, advances in MR imaging technology have allowed the localization of the visual [2,11,23] and sensorimotor cortices [12,17,21,37,38] in volunteers and in patients with brain tumors. Since 1995, several groups have reported obtaining correlations between functional (f)MR imaging and intraoperative electrical cortical stimulation (ECS).…”

“…In reviewing the literature, it is evident that most of the articles, in which correlation is reported between fMR imaging findings and ECS, are presented more as reports on case series than as studies with a standardized protocol (Table 3). [29,[35][36][37]41,[49][50][51] In addition, the patients included in most of the studies were not consecutive, were sometimes selected from a larger patient series, or were simply compared with healthy volunteers. Such reports provided us with more of an anecdotal impression and lead us to question the reliability and consequences of fMR imaging studies in patients with lesions in the central region who have undergone presurgical evaluation.…”