Intra-operative visualization of primary motor cortex and pyramid tract:implementation and clinical experience

Objective To explore the feasibility of neuronavigation based on blood oxygen level dependent functional MRI(BOLD-fMRI) and diffusion tensor imaging(DTI) for visualization of eloquent cortex in microscopic neurosurgery.Methods Two hundred and seventy-eight patients(156 males and 122 females,aged from 7 to 79 years with mean of 40.7±15.9 years) with space-occupying lesions involving the primary motor cortex and pyramidal tract hospitalized from Feb.2009 to Jul.2010 were involved in present study.Of the 278 patients,231 were with glioma,5 with metastatic tumors,16 with meningioma,18 with cavernous hemangioma,2 with arteriovenous malformation,1 with hemangioendothelioma,3 with germinoma and 2 with lymphocytoma,and all the tumors were resected under functional neuronavigation.The images of hand motor area and pyramidal tract were acquired by BOLD-fMRI and DTI before operation and reconstructed by navigation system,and then projected to the operating microscope for navigation under microscope.The muscle strength,motor function and Karnofsky Performance Scores(KPS) before and after operation were compared and the surgical complications were recorded.Results Of the 278 patients,217(78.1%) achieved a ≥95%,246(88.5%) of ≥90% and 259(93.2%) of ≥80% of resection.The neurological dysfunction was aggravated in 62 cases(22.3%) within 1 week after operation,and the neurological dysfunction was retained in 19 cases(6.8%) only during the follow-up period of 1 to 6 months.Conclusions The visualization of eloquent cortex in microscopic neurosurgery with BOLD-fMRI,DTI and functional neuronavigation was feasible,and it is helpful in maximizing the resection of lesions,minimizing neural injury and promoting post-operative recovery.