Artikel
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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Autoren
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Karl Rössler
- Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
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M. Donat
- Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
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R. Lanzenberger
- Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
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A. Gartus
- Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
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T. Czech
- Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
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E. Knosp
- Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
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R. Beisteiner
- Neurochirurgische Klinik, Arbeitsgemeinschaft für funktionelles MRT, Neurologische Klinik, Medizinische Universität Wien, Wien /A
| Veröffentlicht: | 23. April 2004 |
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Gliederung
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.
