Evaluation of preoperative high magnetic field motor functional MRI (3 Tesla) in glioma patients by navigated electrocortical stimulation and postoperative outcome
Evaluation of preoperative high magnetic field motor functional MRI (3 Tesla) in glioma patients by navigated electrocortical stimulation and postoperative outcome
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DOI：
10.1136/jnnp.2004.050286
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发表时间：
2005-08-01
影响因子：
11
通讯作者：
Beisteiner, R
中科院分区：
文献类型：
--
作者：
Roessler, K;Donat, M;Beisteiner, R
目的：方法：22例（男10例，女12例，年龄10 ~ 65岁，平均39岁）脑胶质瘤患者术前行功能性磁共振成像（fMRI）检查，进行包括手、足、口运动在内的运动任务。最近开发的高场临床功能磁共振成像技术被用来生成术前功能的高风险领域的地图，定义一个运动焦点。通过术中运动皮层刺激（MCS）采用图像融合和神经导航来测试运动病灶的有效性。结果：所有患者术前均能成功检测到功能磁共振运动病灶。22例患者中有17例（77.3%）成功刺激了初级运动皮层。所有17名相关患者在MCS和fMRI运动集中在10 mm内显示100%的一致性。3名患者（13.6%）在刺激过程中出现技术问题，2名患者（9.1%）未引起运动反应，3名患者（13.6%）发生MCS诱导的癫痫发作。结合fMRI和MCS标测结果，允许20例患者（91%）进行大切除（9例（41%）进行大体切除，11例（50%）进行小计），2例患者（9%）进行活检。病理结果显示7个低级别和15个高级别胶质瘤。6例患者发生轻度至中度一过性神经功能恶化，1例发生重度轻偏瘫。所有患者在3个月内恢复（31.8%短暂的，0%永久性发病率）。结论：临床优化的高磁场运动功能磁共振成像的验证证实了高可靠性作为一个术前和术中辅助胶质瘤患者选择手术内或邻近的运动皮质。
Objectives: The validity of 3 Tesla motor functional magnetic resonance imaging ( fMRI) in patients with gliomas involving the primary motor cortex was investigated by intraoperative navigated motor cortex stimulation (MCS).Methods: Twenty two patients ( 10 males, 12 females, mean age 39 years, range 10 - 65 years) underwent preoperative fMRI studies, performing motor tasks including hand, foot, and mouth movements. A recently developed high field clinical fMRI technique was used to generate pre-surgical maps of functional high risk areas defining a motor focus. Motor foci were tested for validity by intraoperative motor cortex stimulation ( MCS) employing image fusion and neuronavigation. Clinical outcome was assessed using the Modified Rankin Scale.Results: FMRI motor foci were successfully detected in all patients preoperatively. In 17 of 22 patients (77.3%), a successful stimulation of the primary motor cortex was possible. All 17 correlated patients showed 100% agreement on MCS and fMRI motor focus within 10 mm. Technical problems during stimulation occurred in three patients (13.6%), no motor response was elicited in two (9.1%), and MCS induced seizures occurred in three ( 13.6%). Combined fMRI and MCS mapping results allowed large resections in 20 patients (91%) ( gross total in nine (41%), subtotal in 11 (50%)) and biopsy in two patients (9%). Pathology revealed seven low grade and 15 high grade gliomas. Mild to moderate transient neurological deterioration occurred in six patients, and a severe hemiparesis in one. All patients recovered within 3 months (31.8% transient, 0% permanent morbidity).Conclusions: The validation of clinically optimised high magnetic field motor fMRI confirms high reliability as a preoperative and intraoperative adjunct in glioma patients selected for surgery within or adjacent to the motor cortex.