The use of high-field intra-operative magnetic resonance imaging combined with language functional neuronavigation in glioma surgery

Objective To explore the effect of high-field intra-operative magnetic resonance imaging(iMRI) combined with language functional neuronavigation in resection of glioma in language area of dominant hemisphere of the brain.Methods Twenty right handed patients(12 males and 8 females,aged from 20 to 61 years with mean of 43.6 years) with glioma close to arcuate fasciculus were involved in present study,and they were stratified into normal group(n=9) and aphasia group(n=11) according to the preoperative aphasia quotient(AQ).All the patients underwent surgical operation assisted by arcuate fasciculus navigator,and the high-field iMRI was performed with a 1.5-T magnetic resonance scanner.The 3D reconstructed arcuate fasciculus images were integrated into neuronavigation system before the operation,and used by combining with functional neuronavigation under microscope during the surgical procedure.Pre-operatirely,and 2-4 weeks,3-6 months postoperative,the patients were examined with magnetic resonance scanning and aphasia quotients examination.Results Pre-operative and intra-operative arcuate fasciculus reconstruction was completed in all the 20 patients,and neuronavigation under microscope were performed after the 3D images integrated into neuronavigation system.Patients of normal AQ(94.5±5.5) retained the normal level,except one patients who developed new conduction aphasia syndrome(AQ=81.8) 2-4 weeks after operation.The AQ of aphasia group(89.4±5.8) was significantly improved than that before operation(84.9±8.7,P < 0.05),except 2 patients whose language deficit was exacerbated due to tumor recurrence.The AQ of normal group(98.3±0.5) remained at normal level,while that of aphasia group(95.2±2.6) was significantly improved 3-6 months after operation compared with that at 2-4 weeks after operation(P < 0.05).There were no other new neurologic deficits and death in both groups.Conclusion High-field iMRI combined with functional neuronavigation is a safe and reliable technique for maximal resection of tumors adjacent to important language areas or conduction tracts,with minimal neural injury,and is beneficial to post-operative recovery.