Limitations of functional neuroimaging for patient selection and surgical planning in glioma surgery

Abstract

<jats:p>The optimal surgical management of gliomas requires a balance between surgical cytoreduction and preservation of neurological function. Preoperative functional neuroimaging, such as functional MRI (fMRI) and diffusion tensor imaging (DTI), has emerged as a possible tool to inform patient selection and surgical planning. However, evidence that preoperative fMRI or DTI improves extent of resection, limits neurological morbidity, and broadens surgical indications in classically eloquent areas is lacking. In this review, the authors describe facets of functional neuroimaging techniques that may limit their impact on neurosurgical oncology and critically evaluate the evidence supporting fMRI and DTI for patient selection and operative planning in glioma surgery. The authors also propose alternative applications for functional neuroimaging in the care of glioma patients.</jats:p>

Functional Mapping before and after Low-Grade Glioma Surgery: A New Way to Decipher Various Spatiotemporal Patterns of Individual Neuroplastic Potential in Brain Tumor Patients

“…Moreover, navigated repetitive TMS (rTMS) has only an 81.6% sensitivity, 59.6% specificity, 78.5% positive predictive value, and 64.1% negative predictive value for preoperative language mapping in brain tumor patients [ 10 ]. Therefore, preoperative FNI and TMS are currently not sufficient for efficient and reliable detection of cortical hubs and WM pathways critical for neural functions [ 11 ].…”

Neurosurgical applications of tractography in the UK

“…Further work in the areas of pulse sequence development (such as high angular resolution diffusion imaging) and iMRI workflow will need to address these constraints to deliver on the promise of flexible yet accurate intra-operative tractography, which has so far proved elusive. 23 A key finding from this survey is the logistical difficulty encountered by many units in deploying tractography. Reconstructions are most commonly performed by neuroradiologists or imaging scientists and medical physicists, usually with an affiliation to an academic centre.…”

Assessment of a Reliable Fractional Anisotropy Cutoff in Tractography of the Corticospinal Tract for Neurosurgical Patients

“…Tractography of the corticospinal tract has become a routine technique for planning neurosurgical procedures in the eloquent areas of the brain. However, tractography still suffers from uncertain accuracy and reproducibility [ 1 , 2 ]. There is increasing evidence that, if correctly applied, tractography can reliably predict the position of fiber bundles to a degree of some millimeters [ 3 ].…”