Utilidad de la resonancia magnética funcional y tractografía en la planificación y resección quirúrgica de lesiones cerebrales

Abstract

Aim. We describe the advantages of incorporating functional magnetic resonance imaging and tractography in patients with brain lesions who are candidates for surgery and illustrate with cases of our institution. Material and methods. The goal of surgical treatment in patients is to maximize brain lesions resection minimizing the subsequent neurological deficit. The functional resonance imaging (fMRI) technique indirectly detects neuronal activity in the brain, capturing changes in hemoglobin oxygen levels caused by the increase in energy consumption of the brain cells involved in performing a task. Consequently, a non-invasive cortical map is obtained fast, that can be repeated (test-retest) and that maps the entire brain. Tractography is a three-dimensional representation of the nerve fibers pathway of the brain, obtained from diffusion images applied in several spatial directions. It is the only non-invasive technique capable of reconstructing the structure of white brain substance. Results. We presented 7 cases with processing and integration of MRI and tractography, which makes it possible to incorporate relevant information for decision making in patients candidates for surgery, providing the topographic relationship between the lesion, nerve fibers and the most important functional areas. Conclusion. The use of MRI and tractography allows for a better planning of the trajectory of the resection and minimize the risk of postoperative neurological deficit. In addition, the cortical map obtained with MRI serves as a guide for intraoperative cortical stimulation, avoiding "de novo" mapping, which reduces the time of surgery and anesthesia. Finally, knowledge of nerve fibers trajectory improves the delimitation of safe margins of resection and provides information on the eventual infiltrative nature of the lesion.