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

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Navigated intraoperative motor cortex stimulation proved high reliability of co-registered motor F-MRT in patients with gliomas involving the primary motor cortex

Evaluierung der Validität funktioneller MRT mittels navigierter Motorkortexstimulation bei in oder um die Zentralregion gelegenen Gliomen unter Verwendung funktioneller Risikokarten

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  • corresponding author Karl Rössler - Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
  • M. Donat - Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
  • R. Lanzenberger - Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
  • A. Gartus - Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
  • T. Czech - Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
  • E. Knosp - Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
  • R. Beisteiner - Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A

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.01.02

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0018.shtml

Published: April 23, 2004

© 2004 Rössler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

The validity of motor F-MRI risk maps generated by a high quality head fixation and high correlation thresholds in patients with gliomas involving the primary motor cortex was investigated by intraoperative navigated motor cortex stimulation (MCS).

Methods

From May 1999 to August 2003, altogether 22 patients (10 male, 12 female, mean age 39) with gliomas involving the primary motor cortex (3 grade I, 4 grade II, 5 grade III und 10 GBMs) were preoperatively investigated in a 3 Tesla MRI (Bruker, Ettlingen, Germany) performing motor tasks for hand, food, mouth and chin movements using individually prepared plaster cast helmet head restrain systems and application of high voxel correlation thresholds. Generated F-MRI risk maps were co-registered to a 1.5 Tesla T1 gadolineum volume sequence und projected onto the operating field with a neuronavigation system (EGN/Philips 5, MKM Zeiss 7 und StealthTREON/Medtronic 10). Intraoperative navigated MCS was performed (OCS-1, Radionics, Germany) on the basis of these F-MRT motor risk areas and motor responses correlated to the preoperative tasks.

Results

In 17 of 22 patients (77%), the anatomical fMRT risk area could be identified by MCS, in all 17 (100%) patients a total or partial correlation to the preoperative identified fMRT risk area and motor task was found. MCS induced seizures occurred in 2 patients, which were interrupted easily by rinsing with cold liquor and by application of an additional sedativum bolus. In 2 patients, no motor response was detectable, additional 3 patients were not stimulated intraoperatively by other reasons. Altogether, a gross total resection was achieved in 9 patients, a subtotal resection in 11 patients and 2 patients had a biopsy, as a consequence of motor responses in the tumor areas. Transient mild or moderate neurological deterioration occurred in 4 patients, severe hemiparesis in 1 patient, but all patients recovered within weeks.

Conclusions

The correlation of motor fMRT and intraoperative MCS had a 100% specificity in our study, apparently due to technical refinements in F-MRI studies. Therefore, the preoperative evaluation of patients with gliomas involving the primary motor cortex should include a motor- fMRT investigation, but by now should not replace the intraoperative MCS for resection guidance. This concept seems to reduce permanent morbitidy in this patient group.