MRI Guidance of Intracranial Tumor Resections
To achieve the primary goal of maximum extent of resection for intracranial lesions with preservation of neurological function, intraoperative MRI serves as immediate feedback on the surgical result and in this way is used for quality control. With the ability to compensate for the effects of brain shift, various studies have shown the contribution of intraoperative MRI to extended tumor resection. This is of special interest for neuroepithelial lesions, which are the most common primary brain tumors and furthermore are hard to distinguish from physiological brain parenchyma. Although for a long time the role of surgery in the treatment of these lesions was discussed, recent literature favors their maximum extent of resection. Navigation-guided surgery is routinely used in neurosurgical operating theaters, with the segmented outlines of the lesion of interest and the surrounding risk structures being displayed in the microscope’s heads-up display. Currently, not only anatomical image data can be integrated in the navigation system, so can information on functional brain structures. Magnetoencephalography and functional MRI display eloquent cortical areas, and fiber tractography based on diffusion tensor imaging displays the associated subcortical fiber bundles. The visualization of metabolically active brain areas is enabled by single photon emission computed tomography, positron emission tomography, or magnetic resonance spectroscopic imaging. With these additional data integrated in the navigation system, which is nowadays called “multimodality navigation” studies have shown a reduction of postoperative morbidity. In this chapter we do not aim to discuss the various forms of intraoperative MRI; however, we want to focus on the integration of multimodality navigation in the setting of intraoperative MRI scanning.
KeywordsFractional Anisotropy Diffusion Tensor Imaging Blood Oxygen Level Dependency Blood Oxygen Level Dependency Signal Magnetic Resonance Spectroscopic Imaging
- Kuhnt D, Becker A, Ganslandt O, Bauer M, Buchfelder M, Nimsky C (2011a) Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field intraoperative MRI guidance. Neuro Oncol. [Epub ahead of print]Google Scholar
- Wolf M, Vogel T, Weierich P (2001) Automatic transfer of preoperative fMRI markers into intraoperative MR-images for updating neuronavigation. IEICE Trans Inf Syst E84-D:1698–1704Google Scholar
- Wu JS, Zhou LF, Tang WJ et al (2007) Clinical evaluation and follow-up outcome of diffusion tensor imaging-based functional neuronavigation: a prospective, controlled study in patients with gliomas involving pyramidal tracts. Neurosurgery 61(5):935–948 (discussion 948–949)PubMedCrossRefGoogle Scholar