gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Functional mapping and DTI fiber tracking used in navigated surgery in the insula

Meeting Abstract

  • Peter Grummich - Neurochirurgische Klinik, Erlangen, Deutschland
  • Karl Rössler - Department of Neurosurgery Erlangen, Erlangen, Deutschland
  • Michael Buchfelder - Universitätsklinikum Erlangen, Klinik für Neurochirurgie, Erlangen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.23.05

doi: 10.3205/17dgnc525, urn:nbn:de:0183-17dgnc5256

Published: June 9, 2017

© 2017 Grummich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Insular gliomas were considered a long time as inoperable, because of high morbidity rates. The reasons for these are adjacent eloquent cortices and white matter tracts as well as the branching middle cerebral artery. FMRI and DTI were used to receive information about these eloquent areas.

Methods: Preoperative functional imaging with fMRI was performed in 9 patients with insular tumors. For fMRI we used a 1.5T MR scanner with echo planar imaging (Sonata, Siemens Medical Solutions) and a block paradigm with 180 measurements in 6 blocks (rest alternating with activation, 25 slices, 3mm thickness & resolution TR=2470, TE=60). During the activation intervals patients had to perform language tasks, presented visually. Correlation maps were calculated and merged with 3D-MR maps. DTI was used with 1.9 mm slices and 6 directions to reconstruct fibre connections of language areas and the pyramidal tract. Repeated language- and calculation tests were conducted pre- and postoperatively to rate the recovery of neurological function. Intraoperative MRI was used and registered to the functional images to show the extent of resection, the brain shift and an update of the relation to functional structures.

Results: Of the 9 patients 7 had surgery in the left and 2 in the right insula. One of the 7 with surgery in the left insula was right dominant. For all 6 left dominant patients language areas at the cranial border of the insula and in the frontal operculum of the inferior frontal gyrus were obtained. None of the 9 patients had a permanent neurologic deficit.3 patients had transitory language problems, which resolved during 2 weeks. No paresis was observed in any patient.

Conclusion: Functional MRI and DTI Fiber tracking together with functional neuronavigation are able to avoid permanent neurologic deficits like aphasia and paresis while maximizing the extant of resection.