Minim Invasive Neurosurg 2009; 52(1): 17-24
DOI: 10.1055/s-0028-1104566
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Surgical Resection of High-grade Gliomas in Eloquent Regions Guided by Blood Oxygenation Level Dependent Functional Magnetic Resonance Imaging, Diffusion Tensor Tractography, and Intraoperative Navigated 3D Ultrasound

S. Gulati 1 , E. M. Berntsen 1 , 2 , 3 , O. Solheim 1 , 5 , K. A. Kvistad 2 , 3 , A. Håberg 2 , 3 , T. Selbekk 4 , 7 , S. H. Torp 6 , G. Unsgaard 1 , 4 , 5
  • 1Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
  • 2Department of Radiology, St. Olavs Hospital, Trondheim, Norway
  • 3Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
  • 4National Centre for 3D Ultrasound in Surgery, St. Olavs Hospital, Trondheim, Norway
  • 5Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
  • 6Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
  • 7SINTEF, Trondheim, Norway
Further Information

Publication History

Publication Date:
26 February 2009 (online)

Abstract

Objective: The aims of this study of patients with high-grade gliomas in eloquent brain areas were 1) to assess the postoperative functional outcome, 2) to determine the extent of tumour resection in these difficult locations, 3) to evaluate the practical usefulness of navigated blood oxygenation level-dependent functional magnetic resonance imaging and diffusion tensor tractography.

Patients and Methods: 25 consecutive patients were included in the study. The patients’ gross functional neurological status was determined using the 7-step modified Rankin scale. The extent of tumour resection was determined using pre- and postoperative T1-weighted or T1-weighted, contrast-enhanced MRI images.

Results: The average preoperative modified Rankin scale was 1.56±0.77, whereas the average postoperative modified Rankin scale was 1.08±1.29. There was a significant improvement in mean modified Rankin scale score after surgery. The mean percentage of residual tumour was calculated to 16±22% of the original tumour volume (median 8%). Blood oxygenation level-dependent functional magnetic resonance imaging and diffusion tensor tractography were performed in 23 and 18 patients, respectively. Blood oxygenation level-dependent functional magnetic resonance imaging and diffusion tensor tractography facilitated identification of probable functional regions in 91% and 94% of the respective investigations.

Conclusion: We feel that the combination of blood oxygenation level-dependent functional magnetic resonance imaging, diffusion tensor tractography, and 3D ultrasound facilitated maximal tumour resection with minimal deficits. The method permits an image-based functional monitoring of the brain during surgery that may aid the preservation of motor and language function.

References

Correspondence

Dr. S. Gulati

Department of Neurosurgery

St. Olavs Hospital

N-7006 Trondheim

Norway

Phone: +47/95/784 855

Email: sasha.gulati@stolav.no

Email: sashagulati@hotmail.com