gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Risk profile for surgery in the central region based on functional MRI

Risikoprofil für Eingriffe in der Zentralregion anhand von funktionellen kernspintomographischen Daten

Meeting Abstract

  • corresponding author René Krishnan - Klinik und Poliklinik für Neurochirurgie der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • E. Hattingen - Institut für Neuroradiologie der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • E. Hermann - Klinik und Poliklinik für Neurochirurgie der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • H. Yahya - Klinik und Poliklinik für Neurochirurgie der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • A. Szelényi - Klinik und Poliklinik für Neurochirurgie der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • A. Raabe - Klinik und Poliklinik für Neurochirurgie der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • V. Seifert - Klinik und Poliklinik für Neurochirurgie der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.06.03

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0064.shtml

Veröffentlicht: 23. April 2004

© 2004 Krishnan et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Functional magnetic resonance imaging becomes important to the neurosurgeon at four key stages in the clinical management of his patients: 1) assessing the feasibility of radical surgical resection, 2) surgical planning, 3) selecting patients for invasive functional mapping procedures and, 4) intraoperative visualization of functional areas. In this prospective study we have examined the occurrence of a new post-operative motor deficit, as a function of a lesion's distance from the functional areas, as provided by functional magnetic resonance imaging.

Methods

Sixty-seven patients (34 male, 33 female, aged 22-76 years, mean age 51 years) with different pathologies in close proximity to the motor cortex, were included in the protocol. Pre-operative EPI T2* BOLD imaging was performed during standardized paradigms for hand, foot and tongue movement. Data analysis was done with BrainVoyager software (Brain Innovation, Maastricht, NL). For functional neuronavigation we use the Vector Vision2 system (BrainLAB, Heimstetten, Germany). Outcome was analyzed as a function of a lesions distance to functional motor areas, resection grade, lesion size, patient age and histology. Regarding the distance of a lesion to the motor areas (=LAD), four risk groups were graded. The end point of this study was the clinical outcome 15 days post-operatively.

Results

Gross total resection was achieved in 56 patients. 11 patients (low grade glioma = 4, glioblastoma = 7) had a subtotal resection. The neurological outcome improved in 22 patients (33%), was unchanged in 36 patients (54%) and deteriorated in 9 patients (13%). Significant predictors of a new neurological deficit were a lesion to activation distance < 5mm (p<0,01) and subtotal resection (p<0,05).

Conclusions

The determination of a lesion's proximity to the primary motor cortex, based on pre-operative functional MRI, may be a key in predicting the risk of post-operative deterioration. Our data suggest that a lesion to activation distance < 5mm is associated with a higher risk for neurological deterioration. Taking the potential errors of functional imaging, image fusion, as well as patient registration in the OR into account, we suggest performing cortical stimulation within a 10 mm LAD. For a distance > 10 mm a complete resection can be achieved safely.