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

Combination of intraoperative monitoring, functional magnetic resonance imaging and use of neuronavigation in operations near the sensorimotor cortex

Kombination von intraoperativem Monitoring, funktioneller Kernspintomographie und Einsatz der Neuronavigation bei Operationen in der Nähe des sensomotorischen Kortex

Meeting Abstract

  • corresponding author Dirk Rasche - Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg
  • R. Metzner - Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg
  • C. Stippich - Neurologische Klinik, Abteilung Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg
  • A. Unterberg - Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg
  • V. Tronnier - Neurochirurgische Klinik, Universitätsklinikum Heidelberg, Heidelberg

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. DocP 08.78

The electronic version of this article is the complete one and can be found online at:

Published: April 23, 2004

© 2004 Rasche et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




Intracerebral tumours or vascular malformations near the sensorimotor cortex are difficult to operate because of the high risk of postoperative neurological deficits. The aim of this prospective study was to examine the use of intraoperative monitoring, neuronavigation, and additionally, data from functional magnetic resonance imaging (fMRI) to prevent postoperative neurological deficits.


Ten patients with tumours near the central sensorimotor cortical area and with infiltration of the subcortical layers near the corticospinal tract were operated. No neurological deficits, such as, a persistent hemiparesis was present or disappeared with antiedematous medication. Pre-operative fMRI demonstrated the relationship of the tumour, the pericentral area and the corticospinal tract. These data were combined and matched with the morphological neuronavigation data. Intraoperative sensory evoked potentials of the median or tibial nerve were recorded to identify the pre- and postcentral gyrus. By using a navigable tool for cortex stimulation, the primary motor cortex could be electrophysiologically identified and the location also matched in the neuronavigation data.


In all patients the combination of the different methods was successful. By matching the fMRI data with the neuronavigation system, the pre- and postcentral gyrus could be identified. This could be confirmed in all cases by intraoperative electrophysiology with motor cortex stimulation and phase inversion of evoked potentials. Intraoperative shifting was less than two millimetres. An excellent correlation of the electrophysiological and morphological data was observed. In the postoperative course no persistent neurological deficit could be demonstrated. In two cases a temporary hemiparesis was noted but recovered within ten days. The mean duration of intraoperative prolongation was one hour, mainly because of matching the neuronavigation data and motor cortex stimulation.


The matching of fMRI and neuronavigation data can be confirmed by intraoperative monitoring and direct identification of the pre- and postcentral gyrus. Intraoperative neurophysiologic data and neuronavigation helps the neurosurgeon to avoid manipulation and damage near functional areas. The combination of electrophysiological and morphological data showed an exact and excellent correlation. The prolongation of the operation time is moderate and tolerable. The described method and techniques are practicable and helpful in patients with tumours near eloquent areas like the sensorimotor region and the corticospinal tract.