The central sulcal vein: a landmark for identification of the central sulcus using functional magnetic resonance imaging

Abstract

The authors evaluated the anatomical location of the central sulcus (CS) in 24 cerebral hemispheres (eight in which tumors were located centrally, 16 in controls) using: 1) classic anatomical landmarks seen on magnetic resonance (MR) imaging (24 hemispheres); 2) functional MR imaging (24 hemispheres); and 3) intraoperative electrical stimulation mapping (eight hemispheres). On MR imaging the CS was identified with certainty in 79% of hemispheres (four of eight in patients, 15 of 16 in controls). Functional MR imaging identified a parenchymal "motor hand area" in only 83% (20 of 24 hemispheres; five of eight in patients, 15 of 16 in controls); this area was located in the precentral gyrus in 16 (80%) of 20, additionally in the postcentral gyrus in 10 (50%) of 20, and exclusively in the postcentral gyrus in four (20%) of 20. In contrast, functional MR imaging detected one to three sulcal veins presumably draining blood from the adjacent motor hand area in 100% (24 of 24) of the hemispheres studied, and anatomical MR imaging and intraoperative mapping localized these veins in the CS. It is concluded that sulcal veins lying deep within the CS: 1) drain activated blood from the adjacent pre- or postcentral cortex during performance of a motor hand task; 2) can be identified easily with functional MR imaging; and 3) are an anatomical landmark for noninvasive identification of the CS and thus the sensorimotor strip. The detection of these veins provides a more consistent landmark than the detection of parenchymal motor areas by functional MR imaging; this technique may be used when classic anatomical landmarks fail to identify the sensorimotor strip.

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

“…Since 1995, several groups have reported obtaining correlations between functional (f)MR imaging and intraoperative electrical cortical stimulation (ECS). [17,29,36,41,[49][50][51] Efforts in these mostly preliminary studies have focused primarily on neurophysiological and/or neuroradiological aspects and, because of the novelty of the technique, have included poorly standardized protocols and selective, not consecutive, series of patients.In the present work we attempt, by using a standardized protocol, to validate intraoperatively the fMR imaging technique for localization of the motor cortex in a consecutive series of patients with tumors in the central region. We focus primarily on the surgical applicability of this new technology and cortical reorganization phenomena observed in patients whose lesions involved the primary sensorimotor cortex.…”

“…Because MR systems are more likely to be available in many institutions, a better understanding and validation of fMR imaging will be more easily performed by neurosurgeons who treat tumors located close to or within eloquent areas. Regardless of the enthusiasm arising from fMR imaging techniques in the preoperative evaluation, neurosurgeons have to be aware that: 1) fMR imaging is an indirect indicator of cerebral activation, because it measures changes in regional cerebral blood flow (rCBF) and not neuronal activity itself, such as is accomplished by magnetoencephalography; [2,15,24,31] 2) changes in blood oxygenation are characterized by a spatial and temporal dispersion that may cause errors in the accurate localization of activated areas (such as nonparenchymal deoxyhemoglobin changes in intraparenchymal capillaries or sulcal veins); [24,51] and 3) emerging functional imaging techniques or new applications of these have to be evaluated and validated objectively with gold-standard brain mapping techniques that are still considered safe and accurate to avoid neurological deficits or postoperative deterioration in patients undergoing removal of central lesions. …”

“…Since 1995, several groups have reported obtaining correlations between functional (f)MR imaging and intraoperative electrical cortical stimulation (ECS). [17,29,36,41,[49][50][51] Efforts in these mostly preliminary studies have focused primarily on neurophysiological and/or neuroradiological aspects and, because of the novelty of the technique, have included poorly standardized protocols and selective, not consecutive, series of patients.…”

The Zeiss-MKM system for frameless image-guided approach in epidural motor cortex stimulation for central neuropathic pain

“…Axial 3D T 1 -weighted MR images (130 slices) of the brain were transferred into a stereotaxis planning workstation (STP4.0; Leibinger/Fischer, Freiburg, Germany), allowing multiplanar visualization of the brain structures, especially the cortical sulci. The central sulcus was localized 36 and its precise shape registered in the 3D planning workstation (Fig. 1).…”

“…26,27,36 Unfortunately, the correlation of data obtained using these modalities revealed the practical limitations of intraoperative SSEP recordings, thus indicating the potential superiority of fMR imaging as a localizing technique in this indication. Indeed, in all patients fMR imaging was also performed.…”