Summary
Background. Some brain tumors may grow immediately beneath the cortical surface without distorting its appearance. Intraoperative image guidance promotes safe resection. We have developed MRI-based corticotopography (MRI-bct), to localize lesions during surgery, using simple, non-dedicated equipment, to match a three-dimensional reconstruction with the corresponding appearance of the brain cortex.
Methods. Forty-six patients underwent resection of subcortical brain lesions, aided by MRI-bct. The lesions had a maximum diameter less than 3 cm, were subcortical but no deeper than the floor of the nearest cerebral sulcus. Each patient had a volumetric MRI scan with and without contrast administration. Data sets were transferred to a laptop personal computer and processed using a rendering software. At operation, the three-dimensional model of the brain, including a surface overlay of the lesion, was matched to the exposed brain surface. After its exact relationship with the overlying sulcal pattern was defined, the lesion was localized and resected. In selected patients, the procedure was coupled with functional brain mapping.
Results. Data processing took from 10 to 15 min and could be done whenever convenient before operation. Surface matching between the surgical field and the reformatted MRI always required less than 5 min and was done near the operating table. In all patients, the lesion was identified at the first attempt, through a small corticotomy, regardless of the brain shift after dural opening.
Conclusions. MRI-bct is a practical, time-saving neuronavigational aid ideal for localizing superficial lesions underlying the cerebral cortex because it unmistakably characterizes the adjacent sulcal anatomy.
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References
AC Bastos RM Comeau F Andermann D Melanson F Cendes F Dubeau S Fontaine D Tampieri A Olivier (1999) ArticleTitleDiagnosis of subtle focal dysplastic lesions: curvilinear reformatting from three-dimensional magnetic resonance imaging Ann Neurol 46 88–94 Occurrence Handle10401784 Occurrence Handle10.1002/1531-8249(199907)46:1<88::AID-ANA13>3.0.CO;2-4 Occurrence Handle1:STN:280:DyaK1MzivVaisw%3D%3D
AC Bastos IP Korah F Cendes D Melanson D Tampieri T Peters F Dubeau F Andermann (1995) ArticleTitleCurvilinear reconstruction of 3D magnetic resonance imaging in patients with partial epilepsy: a pilot study Magn Reson Imaging 13 1107–1112 Occurrence Handle8750323 Occurrence Handle10.1016/0730-725X(95)02019-P Occurrence Handle1:STN:280:DyaK28zlslCluw%3D%3D
H Duffau L Capelle D Denvil N Sichez P Gatignol L Taillandier M Lopes MC Mitchell S Roche JC Muller A Bitar JP Sichez R van Effenterre (2003) ArticleTitleUsefulness of intraoperative electrical subcortical mapping during surgery for low-grade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 patients J Neurosurg 98 IssueID4 764–778 Occurrence Handle12691401
V Esposito S Paolini R Morace (2006) ArticleTitleResection of a left insular cavernoma aided by a simple navigational tool. Technical note Neurosurg Focus 21 e16 Occurrence Handle16859254 Occurrence Handle10.3171/foc.2006.21.1.17
P Grunert W Muller-Forell K Darabi R Reisch C Busert N Hopf A Perneczky (1998) ArticleTitleBasic principles and clinical applications of neuronavigation and intraoperative computed tomography Comput Aided Surg 3 166–173 Occurrence Handle10027490 Occurrence Handle1:STN:280:DyaK1M7kvFOgtA%3D%3D Occurrence Handle10.3109/10929089809148141
HK Gumprecht DC Widenka CB Lumenta (1999) ArticleTitleBrainLab VectorVision Neuronavigation System: technology and clinical experiences in 131 cases Neurosurgery 44 97–104 Occurrence Handle9894969 Occurrence Handle10.1097/00006123-199901000-00056 Occurrence Handle1:STN:280:DyaK1M7htValsg%3D%3D
E Hattingen C Good S Weidauer S Herminghaus P Raab G Marquardt A Raabe V Seifert FE Zanella (2005) ArticleTitleBrain surface reformatted images for fast and easy localization of perirolandic lesions J Neurosurg 102 302–310 Occurrence Handle15739559
GE Keles (2004) ArticleTitleIntracranial neuronavigation with intraoperative magnetic resonance imaging Curr Opin Neurol 17 497–500 Occurrence Handle15247548 Occurrence Handle10.1097/01.wco.0000137543.14610.fd
T Kral M Kurthen J Schramm H Urbach B Meyer (2006) ArticleTitleStimulation mapping via implanted grid electrodes prior to surgery for gliomas in highly eloquent cortex Neurosurgery 58 ONS36–ONS43 Occurrence Handle16479627 Occurrence Handle10.1227/01.NEU.0000193925.98348.F5
C Nimsky A Fujita O Ganslandt KB Von R Fahlbusch (2004) ArticleTitleVolumetric assessment of glioma removal by intraoperative high-field magnetic resonance imaging Neurosurgery 55 358–370 Occurrence Handle15271242 Occurrence Handle10.1227/01.NEU.0000129694.64671.91
DW Roberts A Hartov FE Kennedy MI Miga KD Paulsen (1998) ArticleTitleIntraoperative brain shift and deformation: a quantitative analysis of cortical displacement in 28 cases Neurosurgery 43 749–758 Occurrence Handle9766300 Occurrence Handle10.1097/00006123-199810000-00010 Occurrence Handle1:STN:280:DyaK1cvjslKqsg%3D%3D
C Rorden M Brett (2000) ArticleTitleStereotaxic display of brain lesions Behav Neurol 12 191–200 Occurrence Handle11568431
AH Schulze-Bonhage HJ Huppertz RM Comeau JB Honegger JM Spreer JK Zentner (2002) ArticleTitleVisualization of subdural strip and grid electrodes using curvilinear reformatting of 3D MR imaging data sets Am J Neuroradiol 23 400–403 Occurrence Handle11901007
G Unsgaard S Ommedal T Muller A Gronningsaeter TA Nagelhus Hernes (2002) ArticleTitleNeuronavigation by intraoperative three-dimensional ultrasound: initial experience during brain tumor resection Neurosurgery 50 804–812 Occurrence Handle11904032 Occurrence Handle10.1097/00006123-200204000-00022
J Wadley N Dorward N Kitchen D Thomas (1999) ArticleTitlePre-operative planning and intra-operative guidance in modern neurosurgery: a review of 300 cases Annu R Coll Surg Engl 81 217–225 Occurrence Handle1:STN:280:DC%2BD3c%2Fot1Snug%3D%3D
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Correspondence: Dr. Sergio Paolini, Via G.A. Sartorio 44, 00147 Rome, Italy.
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Esposito, V., Paolini, S., Morace, R. et al. Intraoperative localization of subcortical brain lesions. Acta Neurochir (Wien) 150, 537–543 (2008). https://doi.org/10.1007/s00701-008-1592-z
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DOI: https://doi.org/10.1007/s00701-008-1592-z