Surgical resection of high-grade gliomas in eloquent regions guided by blood oxygenation level dependent functional magnetic resonance imaging, diffusion tensor tractography, and intraoperative navigated 3D ultrasound

• Published in: Minimally invasive neurosurgery Vol. 52; no. 1; p. 17
• Main Authors: Gulati, S, Berntsen, E M, Solheim, O, Kvistad, K A, Håberg, A, Selbekk, T, Torp, S H, Unsgaard, G
• Format: Journal Article
• Language: English
• Published: Germany 01.02.2009
• Subjects: Adult; Aged; Brain Neoplasms - blood; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - surgery; Diffusion Magnetic Resonance Imaging - methods; Female; Glioma - blood; Glioma - diagnostic imaging; Glioma - surgery; Humans; Language; Magnetic Resonance Imaging - methods; Male; Middle Aged; Motor Activity; Neuronavigation - methods; Neurosurgical Procedures - methods; Oxygen - blood; Retrospective Studies; Treatment Outcome; Ultrasonography - methods
• ISSN: 0946-7211
• DOI: 10.1055/s-0028-1104566

The aims of this study of patients with high-grade gliomas in eloquent brain areas were 1) to assess the postoperative functional outcome, 2) to determine the extent of tumour resection in these difficult locations, 3) to evaluate the practical usefulness of navigated blood oxygenation level-dependent functional magnetic resonance imaging and diffusion tensor tractography. 25 consecutive patients were included in the study. The patients' gross functional neurological status was determined using the 7-step modified Rankin scale. The extent of tumour resection was determined using pre- and postoperative T(1)-weighted or T(1)-weighted, contrast-enhanced MRI images. The average preoperative modified Rankin scale was 1.56+/-0.77, whereas the average postoperative modified Rankin scale was 1.08+/-1.29. There was a significant improvement in mean modified Rankin scale score after surgery. The mean percentage of residual tumour was calculated to 16+/-22% of the original tumour volume (median 8%). Blood oxygenation level-dependent functional magnetic resonance imaging and diffusion tensor tractography were performed in 23 and 18 patients, respectively. Blood oxygenation level-dependent functional magnetic resonance imaging and diffusion tensor tractography facilitated identification of probable functional regions in 91% and 94% of the respective investigations. We feel that the combination of blood oxygenation level-dependent functional magnetic resonance imaging, diffusion tensor tractography, and 3D ultrasound facilitated maximal tumour resection with minimal deficits. The method permits an image-based functional monitoring of the brain during surgery that may aid the preservation of motor and language function.