Aggressive brain tumor treatment via fMRI

 In brain injury, neuroimaging

brainsurgery.jpgBrain tumors are a huge problem in neurosurgery. Not only do you have to take into consideration the delicate network of blood supply to the brain that can ultimately lead to further damage to the brain. In addition, the tumor is placed with in a meshwork of cognitive functions. Cutting too much on one side of the tumor can lead to amnesia, too much of another part can lead to aphasia.

To alleviate this problem, MRI is currently being used to identify the tumor through conventional structural scans. In addition functional MRI can be used to identify vital functional nodes that borders to the tumor. In this way, neurosurgery can use a better estimate of the tumor’s position and extent, as well as avoid functional centres. In all, the precision of neurosurgery has improved dramatically with the use of MRI.

In an article in Radiology, a study now shows that the use of structural and functional MRI in preoperative surgical planning both leads to more precise and more efficient surgery. As a brief resume in Medscape.com reports:

In six cases, the neurosurgeon reported that functional MRI results led to a more complete resection, whereas two patients required a smaller craniotomy than had been planned. The surgeons also noted that surgical time was reduced by 15 to 60 minutes in 22 patients. Invasive imaging that would have been required for four patients was avoided.

In practice this has a tremendous impact for the livesof the patients. With the use of preoperative MRI brain tumors can now be more fully ablated, and at the same time patients will have a lower chance of suffering unwanted dysfunctions. From the Radiology paper, we can see this in one female patients. From the description of the patient:

preoperativefmri.jpg

Recurrent left parietal lobe anaplastic astrocytoma in 37-year-old right-handed woman. Surgery was not initially planned because of presumed involvement of receptive speech area. Left inferior and middle frontal gyral activation (yellow arrows) is consistent with dominant expressive speech area and is located at anterior border of more cephalad component of lesion. Left superior and middle temporal gyral activation (green arrows) is consistent with dominant receptive speech area and abuts inferior border of temporal component of lesion, with superior temporal gyral activation component lying anteroinferior to lesion. Biopsy was performed, and no postoperative neurologic deficits were documented.

-Thomas

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