Functional magnetic resonance imaging-integrated neuronavigation

Correlation between lesion-to-motor cortex distance and outcome

René Krishnan, Andreas Raabe, Elke Hattingen, Andrea Szelényi, Hilal Yahya, Elvis Hermann, Michael Zimmermann, Volker Seifert, Rudolf Fahlbusch, Oliver Ganslandt, Christopher Nimsky, Peter McL Black, Alexandra Golby, Mitchel S. Berger, Kim Burchiel

Research output: Contribution to journalArticle

121 Citations (Scopus)

Abstract

OBJECTIVE: The integration of functional magnetic resonance imaging (fMRI) data into neuronavigation is a new concept for surgery adjacent to the motor cortex. However, the clinical value remains to be defined. In this study, we investigated the correlation between the lesion-to-fMRI activation distance and the occurrence of a new postoperative deficit. METHODS: fMRI-integrated "functional" neuronavigation was used for surgery around the motor strip in 54 patients. During standardized paradigms for hand, foot, and tongue movements, echo-planar imaging T2* blood oxygen level-dependent sequences were acquired and processed with BrainVoyager 2000 software (Brain Innovation, Maastricht, The Netherlands). Neuronavigation was performed with the VectorVision2 system (BrainLAB, Heimstetten, Germany). For outcome analysis, patient age, histological findings, size of lesion, distance to the fMRI areas, preoperative and postoperative Karnofsky index, postoperative motor deficit, and type of resection were analyzed. RESULTS: In 45 patients, a gross total resection (>95%) was performed, and for 9 lesions (low-grade glioma, 4; glioblastoma, 5), a subtotal resection (80-95%) was achieved. The neurological outcome improved in 16 patients (29.6%), was unchanged in 29 patients (53.7%), and deteriorated in 9 patients (16.7%). Significant predictors of a new neurological deficit were a lesion-to-activation distance of less than 5 mm (P <0.01) and incomplete resection (P <0.05). CONCLUSION: fMRI-integrated neuronavigation is a useful concept to assess the risk of a new motor deficit after surgery. Our data suggest that a lesion-to-activation distance of less than 5 mm is associated with a higher risk of neurological deterioration. Within a 10-mm range, cortical stimulation should be performed. For a lesion-to-activation distance of more than 10 mm, a complete resection can be achieved safely. The visualization of fiber tracks is desirable to complete the representation of the motor system.

Original languageEnglish (US)
Pages (from-to)904-915
Number of pages12
JournalNeurosurgery
Volume55
Issue number4
DOIs
StatePublished - Oct 2004
Externally publishedYes

Fingerprint

Neuronavigation
Motor Cortex
Magnetic Resonance Imaging
Echo-Planar Imaging
Karnofsky Performance Status
Glioblastoma
Tongue
Glioma
Netherlands
Germany
Foot
Software
Hand
Oxygen
Brain

Keywords

  • Functional magnetic resonance imaging
  • Image-guided surgery
  • Neuronavigation
  • Surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Functional magnetic resonance imaging-integrated neuronavigation : Correlation between lesion-to-motor cortex distance and outcome. / Krishnan, René; Raabe, Andreas; Hattingen, Elke; Szelényi, Andrea; Yahya, Hilal; Hermann, Elvis; Zimmermann, Michael; Seifert, Volker; Fahlbusch, Rudolf; Ganslandt, Oliver; Nimsky, Christopher; Black, Peter McL; Golby, Alexandra; Berger, Mitchel S.; Burchiel, Kim.

In: Neurosurgery, Vol. 55, No. 4, 10.2004, p. 904-915.

Research output: Contribution to journalArticle

Krishnan, R, Raabe, A, Hattingen, E, Szelényi, A, Yahya, H, Hermann, E, Zimmermann, M, Seifert, V, Fahlbusch, R, Ganslandt, O, Nimsky, C, Black, PM, Golby, A, Berger, MS & Burchiel, K 2004, 'Functional magnetic resonance imaging-integrated neuronavigation: Correlation between lesion-to-motor cortex distance and outcome', Neurosurgery, vol. 55, no. 4, pp. 904-915. https://doi.org/10.1227/01.NEU.0000137331.35014.5C
Krishnan, René ; Raabe, Andreas ; Hattingen, Elke ; Szelényi, Andrea ; Yahya, Hilal ; Hermann, Elvis ; Zimmermann, Michael ; Seifert, Volker ; Fahlbusch, Rudolf ; Ganslandt, Oliver ; Nimsky, Christopher ; Black, Peter McL ; Golby, Alexandra ; Berger, Mitchel S. ; Burchiel, Kim. / Functional magnetic resonance imaging-integrated neuronavigation : Correlation between lesion-to-motor cortex distance and outcome. In: Neurosurgery. 2004 ; Vol. 55, No. 4. pp. 904-915.
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abstract = "OBJECTIVE: The integration of functional magnetic resonance imaging (fMRI) data into neuronavigation is a new concept for surgery adjacent to the motor cortex. However, the clinical value remains to be defined. In this study, we investigated the correlation between the lesion-to-fMRI activation distance and the occurrence of a new postoperative deficit. METHODS: fMRI-integrated {"}functional{"} neuronavigation was used for surgery around the motor strip in 54 patients. During standardized paradigms for hand, foot, and tongue movements, echo-planar imaging T2* blood oxygen level-dependent sequences were acquired and processed with BrainVoyager 2000 software (Brain Innovation, Maastricht, The Netherlands). Neuronavigation was performed with the VectorVision2 system (BrainLAB, Heimstetten, Germany). For outcome analysis, patient age, histological findings, size of lesion, distance to the fMRI areas, preoperative and postoperative Karnofsky index, postoperative motor deficit, and type of resection were analyzed. RESULTS: In 45 patients, a gross total resection (>95{\%}) was performed, and for 9 lesions (low-grade glioma, 4; glioblastoma, 5), a subtotal resection (80-95{\%}) was achieved. The neurological outcome improved in 16 patients (29.6{\%}), was unchanged in 29 patients (53.7{\%}), and deteriorated in 9 patients (16.7{\%}). Significant predictors of a new neurological deficit were a lesion-to-activation distance of less than 5 mm (P <0.01) and incomplete resection (P <0.05). CONCLUSION: fMRI-integrated neuronavigation is a useful concept to assess the risk of a new motor deficit after surgery. Our data suggest that a lesion-to-activation distance of less than 5 mm is associated with a higher risk of neurological deterioration. Within a 10-mm range, cortical stimulation should be performed. For a lesion-to-activation distance of more than 10 mm, a complete resection can be achieved safely. The visualization of fiber tracks is desirable to complete the representation of the motor system.",
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author = "Ren{\'e} Krishnan and Andreas Raabe and Elke Hattingen and Andrea Szel{\'e}nyi and Hilal Yahya and Elvis Hermann and Michael Zimmermann and Volker Seifert and Rudolf Fahlbusch and Oliver Ganslandt and Christopher Nimsky and Black, {Peter McL} and Alexandra Golby and Berger, {Mitchel S.} and Kim Burchiel",
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AU - Raabe, Andreas

AU - Hattingen, Elke

AU - Szelényi, Andrea

AU - Yahya, Hilal

AU - Hermann, Elvis

AU - Zimmermann, Michael

AU - Seifert, Volker

AU - Fahlbusch, Rudolf

AU - Ganslandt, Oliver

AU - Nimsky, Christopher

AU - Black, Peter McL

AU - Golby, Alexandra

AU - Berger, Mitchel S.

AU - Burchiel, Kim

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AB - OBJECTIVE: The integration of functional magnetic resonance imaging (fMRI) data into neuronavigation is a new concept for surgery adjacent to the motor cortex. However, the clinical value remains to be defined. In this study, we investigated the correlation between the lesion-to-fMRI activation distance and the occurrence of a new postoperative deficit. METHODS: fMRI-integrated "functional" neuronavigation was used for surgery around the motor strip in 54 patients. During standardized paradigms for hand, foot, and tongue movements, echo-planar imaging T2* blood oxygen level-dependent sequences were acquired and processed with BrainVoyager 2000 software (Brain Innovation, Maastricht, The Netherlands). Neuronavigation was performed with the VectorVision2 system (BrainLAB, Heimstetten, Germany). For outcome analysis, patient age, histological findings, size of lesion, distance to the fMRI areas, preoperative and postoperative Karnofsky index, postoperative motor deficit, and type of resection were analyzed. RESULTS: In 45 patients, a gross total resection (>95%) was performed, and for 9 lesions (low-grade glioma, 4; glioblastoma, 5), a subtotal resection (80-95%) was achieved. The neurological outcome improved in 16 patients (29.6%), was unchanged in 29 patients (53.7%), and deteriorated in 9 patients (16.7%). Significant predictors of a new neurological deficit were a lesion-to-activation distance of less than 5 mm (P <0.01) and incomplete resection (P <0.05). CONCLUSION: fMRI-integrated neuronavigation is a useful concept to assess the risk of a new motor deficit after surgery. Our data suggest that a lesion-to-activation distance of less than 5 mm is associated with a higher risk of neurological deterioration. Within a 10-mm range, cortical stimulation should be performed. For a lesion-to-activation distance of more than 10 mm, a complete resection can be achieved safely. The visualization of fiber tracks is desirable to complete the representation of the motor system.

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