Preoperative fMRI, Tractography and Continuous Task during Awake Surgery for Maintenance of Motor Function Following Surgical Resection of Metastatic Tumor Spread to the Primary Motor Area

Abstract

The goal of the present study was to determine the efficacy of preoperative fMRI, tractography, and intraoperative continuous task during awake surgery in preserving postoperative motor function in patients undergoing resection of metastatic brain tumors in or near the primary motor area. Three patients with metastatic brain tumors in the primary motor area elected to undergo surgical treatment. Preoperative fMRI and tractography were performed, and various primary motor areas (e. g., hand, arm, face and leg) were identified and confirmed by cortical mapping or by the outcome of awake surgery. Cortical mapping and continuous appropriate task were performed during awake surgery. Preoperative fMRI and tractography correctly identified the primary motor area. In contrast, cortical mapping identified the gyrus of the primary motor area but was unable to identify specific primary motor areas, such as those for the hand or arm, which were compressed by the tumor. Tumor resection was terminated when any deterioration in continuous task performance was observed during awake surgery. Paresis was transient and resolved within one week in all cases. The combination of preoperative fMRI, tractography and continuous task during awake surgery helped to maintain motor function following surgical management of metastatic brain tumors of the primary motor cortex.

Key words

Awake surgery - fMRI - metastatic brain tumor - primary motor area - tractography

References

• 1 Guye M, Parker G JM, Symms M, Boulby P, Wheeler-Kingshott C AM, Salek-Haddadi A, Barker G J, Duncan J S. Combined functional MRI and tractography to demonstrate the connectivity of the human primary motor cortex in vivo.  Neuroimage. 2003;  19 1349-1360
• 2 Kamada K, Houkin K, Iwasaki Y, Takeuchi F, Kuriki S, Mitsumori K, Sawamura Y. Rapid identification of the primary motor area by using magnetic resonance axonography.  J Neurosurg. 2002;  97 558-567
• 3 Krings T, Reinges M HT, Erberich S, Kemeny S, Rohde V, Spetzger U, Korinth M, Willmes K, Gilsbach J M, Thron A. Functional MRI for presurgical planning: problems, artifacts, and solution strategies.  J Neurol Neurosurg Psychiatry. 2001;  70 749-760
• 4 Moller-Hartmann W, Krings T, Coenen V A, Mayfrank L, Weidemann J, Kranzlein H, Thron A. Preoperative assessment of motor cortex and pyramidal tracts in central cavernoma employing functional and diffusion-weighted magnetic resonance imaging.  Surg Neurol. 2002;  58 302-308
• 5 Yousry T A, Schmid U O, Jassoy A G, Schmidt D, Eisner W E, Reulen H J, Reiser M F, Lissner J. Topography of the cortical motor hand area: prospective study with functional MR imaging and direct motor mapping at surgery.  Radiology. 1995;  195 23-29
• 6 Black P M, Ronner S F. Cortical mapping for defining the limits of tumor resection.  Neurosurgery. 1987;  20 914-919
• 7 Coenen V A, Krings T, Axer H, Weidemann J, Kranzlein H, Hans F J, Thron A, Gilsbach J M, Rohde V. Intraoperative three-dimensional visualization of the pyramidal tract in a neuronavigation system (PTV) reliably predicts true position of principal motor pathways.  Surg Neurol. 2003;  60 381-390
• 8 Ebel H, Ebel M, Schillinger G, Klimek M, Sobesky J, Klug N. Surgery of intrinsic cerebral neoplasms in eloquent areas under local anesthesia.  Minim Invasive Neurosurg. 2000;  43 192-196
• 9 Eisner W, Burtscher J, Bale R, Sweeney R, Koppelstatter F, Golaszewski S, Kolbitsch C, Twerdy K. Use of neuronavigation and electrophysiology in surgery of subcortically located lesions in the sensorimotor strip.  J Neurol Neurosurg Psychiatry. 2002;  72 378-381
• 10 Jack Jr C R, Thompson R M, Butts R K, Sharbrough F W, Kelly P J, Hanson O P, Riederer S J, Ehman R L, Hangiandreou N J, Cascino G D. Sensory motor cortex: correlation of persurgical mapping with functional MR imaging and invasive cortical mapping.  Radiology. 1994;  190 85-92
• 11 Reithmeier T, Krammer M, Gumprecht H, Gerstner W, Lumenta C B. Neuronavigation combined with electrophysiological monitoring for surgery of lesions in eloquent brain areas in 42 cases: a retrospective comparison of the neurological outcome and the quality of resection with a control group with similar lesions.  Minim Invas Neurosurg. 2003;  46 65-71
• 12 Sala F, Lanteri P. Brain surgery in motor areas: the invaluable assistance of intraoperative neurophysiological monitoring.  J Neurosurg Sci. 2003;  47 79-88
• 13 Reese T G, Heid O, Weisskoff R M, Wedeen V J. Reduction of eddy-current-induced distortion in diffusion MRI using a twice-refocused spin echo.  Magn Reson Med. 2003;  49 177-182
• 14 Lazar M, Weinstein D M, Tsuruda J S, Hasan K M, Arfanakis K, Meyerand M E, Badie B, Rowley H A, Haughton V. Field A, Alexander AL. White matter tractography using diffusion tensor deflection.  Hum Brain Mapp. 2003;  18 306-321
• 15 Conturo T E, Lori N F, Cull T S, Akbudak E, Snyder A Z, Shimoi J S, McKinstry R C, Burton H, Raichle M E. Tracking neuronal fiber pathways in the living human brain.  Proc Natl Acad Sci USA. 1999;  96 10 422-10 427
• 16 Xue R, van Zijl P C, Crain B J, Solaiyappan M, Mori S. In vivo three-dimensional reconstruction of rat brain axonal projections by diffusion tensor imaging.  Magn Reson Med. 1999;  42 1123-1127
• 17 Friston K J, Frith C D, Liddle P F, Frackowiak R S. Comparing functional (PET) images: the assessment significant change.  J Cereb Blood Flow Metab. 1991;  11 690-699
• 18 Tongier W K, Joshi G P, Landers O F, Mickey B. Use of the laryngeal mask airway during awake craniotomy for tumor resection.  J Clin Anesth. 2000;  12 592-594
• 19 Berger M S, Kincaid J, Ojemann G A, Lettich E. Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors.  Neurosurgery. 1989;  25 786-792
• 20 Ojemann G, Ojemann J, Lettich E, Berger M. Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients.  J Neurosurg. 1989;  71 316-326
• 21 Yetkin F Z, Mueller W M, Morris G L, McAuliffe T L, Ulmer J L, Cox R W, Daniels D L, Haughton V M. Functional MR activation correlated with intraoperative cortical mapping.  AJNR Am J Neuroradiol. 1997;  18 1311-1315
• 22 Krings T, Topper R, Willmes K, Reinges M HT, Gilsbach J M, Thron A. Activation in primary and secondary motor areas in patients with CNS neoplasms and weakness.  Neurology. 2002;  58 381-390
• 23 Carpentier A C, Constable T, Schlosser M J, Lotbiniere A, Piepmeier J M, Spencer D D, Awad I A. Patterns of functional magnetic resonance imaging activation in association with structural lesions in the rolandic region: a classification system.  J Neurosurg. 2001;  94 946-954
• 24 Fandino J, Kollias S S, Wieser H G, Valavanis A, Yonekawa Y. Intraoperative validation of functional magnetic resonance imaging and cortical reorganization pattern in patients with brain tumors involving the primary motor cortex.  J Neurosurg. 1999;  91 238-250
• 25 Taylor M D, Bernstein M. Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases.  J Neurosurg. 1999;  90 35-41