An integrated functional magnetic resonance imaging procedure for preoperative mapping of cortical areas associated with tactile, motor,language, and visual functions Journal Article

  

Authors:	Hirsch, J.; Ruge, M. I.; Kim, K. H. S.; Correa, D. D.; Victor, J. D.; Relkin, N. R.; Labar, D. R.; Krol, G.; Bilsky, M. H.; Souweidane, M. M.; Deangelis, L. M.; Gutin, P. H.
Article Title:	An integrated functional magnetic resonance imaging procedure for preoperative mapping of cortical areas associated with tactile, motor,language, and visual functions
Abstract:	OBJECTIVE: To evaluate an integrated battery of preoperative functional magnetic resonance imaging (fMRI) tasks developed to identify cortical areas associated with tactile, motor, language, and visual functions. METHODS: Sensitivity of each task was determined by the probability that a targeted region was activated for both healthy volunteers (n = 63) and surgical patients with lesions in these critical areas (n = 125). Accuracy of each task was determined by the correspondence between the fMRI maps and intraoperative electrophysiological measurements, including somatosensory evoked potentials (n = 16), direct cortical stimulation (n = 9), and language mapping (n = 5), and by preoperative Wada tests (n = 13) and visual field examinations (n = 6). RESULTS: For healthy volunteers, the overall sensitivity was 100% for identification of the central sulcus, visual cortex, and putative Wernicke's area, and 93% for the putative Broca's area (dominant hemisphere). For patients with tumors affecting these regions of interest, task sensitivity was 97% for identification of the central sulcus, 100% for the visual cortex, 91% for the putative Wernicke's area, and 77% for the putative Broca's area. These sensitivities were enhanced by the use of multiple tasks to target related functions. Concordance of the fMRI maps and intraoperative electrophysiological measurements was observed whenever both techniques yielded maps and Wada and visual field examinations were consistent with fMRI results. CONCLUSION: This integrated fMRI task battery offers standardized and noninvasive preoperative maps of multiple critical functions to facilitate assessment of surgical risk, planning of surgical routes, and direction of conventional, intraoperative electrophysiological procedures. Thus, a greater range of structural and functional relationships is brought to hear in the service of optimal outcomes for neurosurgery.
Keywords:	adolescent; adult; child; controlled study; aged; middle aged; major clinical study; treatment planning; preoperative care; nuclear magnetic resonance imaging; neurosurgery; magnetic resonance imaging; preoperative evaluation; sensitivity and specificity; accuracy; brain cortex; reference values; brain diseases; vision; motor activity; language; functional magnetic resonance imaging; motor cortex; brain mapping; cerebral cortex; electrophysiology; monitoring, intraoperative; brain depth stimulation; evoked somatosensory response; touch; dominance, cerebral; visual cortex; visual field; humans; human; male; female; priority journal; article; functional mapping; cerebral neoplasms; intraoperative brain mapping
Journal Title:	Neurosurgery
Volume:	47
Issue:	3
ISSN:	0148-396X
Publisher:	Wolters Kluwer
Date Published:	2000-09-01
Start Page:	711
End Page:	721
Language:	English
PUBMED:	10981759
PROVIDER:	scopus
DOI:	10.1097/00006123-200009000-00037
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-0034521288&partnerID=40&md5=7d5cc1ad377bad406e623b4807de8c07
Notes:	Export Date: 18 November 2015 -- Source: Scopus

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