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Preoperative Blood Oxygen Level-Dependent (BOLD) Functional Magnetic Resonance Imaging (fMRI) of Motor and Somatosensory Function

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Abstract

Surgery in or around the “central region” entails a high risk for intraprocedural damage of the precentral and postcentral gyrus with consecutive motor and sensory deficits that can impact the patient’s quality of life considerably. By noninvasively providing a precise localization of the different representations of the human body in relation to the surgical target, BOLD-fMRI facilitates the selection of candidates for surgery as well as the planning and performance of more aggressive but safe and function-preserving resections (Petrella et al. 2006). This also implies that fMRI plays a role in identifying those patients who are not the ideal candidates for surgery and who may profit more from less invasive therapeutic options like radiation or chemotherapy. Such patients often present with diffusely infiltrating or recurrent malignancies of the brain, and a complete resection and a surgical cure cannot be achieved. In this situation, deficits associated with the treatment should be kept to a minimum. Prior to treatment, fMRI provides important diagnostic information to evaluate the risks and chances on an individual basis and to optimize the therapeutic strategy accordingly. In addition, functional landmarks are helpful to plan partial resections or biopsies. This also applies for awake craniotomies or epilepsy surgery. Hence, the majority of preoperative fMRI studies are performed in patients with brain tumors and epilepsies to preserve the adjacent eloquent brain areas. In nonresective neurosurgery, also fMRI can be applied, for example, in patients with medically intractable chronic pain. Here, it has been demonstrated that fMRI facilitates the placement of stimulation electrodes over the motor cortex (Pirotte et al. 2005a, b). Ideally, preoperative fMRI studies are conducted for functional neuronavigation and in combination with diffusion tensor imaging (DTI), to also visualize important fiber bundles during surgery, for example, the pyramidal tract (Nimsky et al. 2006).

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Text and figures have been reproduced in part from Stippich 2007 with permission.

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  1. Division of Diagnostic and Interventional Neuroradiology, University Hospitals Basel, Petersgraben 4, Basel, 4031, Switzerland

    Christoph Stippich M.D.

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    Stephan Ulmer

  2. Inst. Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Str. 2, Kiel, 24105, Germany

    Olav Jansen

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Stippich, C. (2013). Preoperative Blood Oxygen Level-Dependent (BOLD) Functional Magnetic Resonance Imaging (fMRI) of Motor and Somatosensory Function. In: Ulmer, S., Jansen, O. (eds) fMRI. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-34342-1_8

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