Roux F E, Ibarrola D, Tremoulet M, Lazorthes Y, Henry P, Sol J C, Berry I
Institut National de la Santé et de la Recherche Médicale, Unité 455, Federation of Neurosurgery, Hôpitaux Purpan and Rangueil, F-31059 Toulouse, France.
Neurosurgery. 2001 Nov;49(5):1145-56; discussion 1156-7. doi: 10.1097/00006123-200111000-00025.
The aim of this article was to analyze the technical and methodological issues resulting from the use of functional magnetic resonance image (fMRI) data in a frameless stereotactic device for brain tumor or pain surgery (chronic motor cortex stimulation).
A total of 32 candidates, 26 for brain tumor surgery and six chronic motor cortex stimulation, were studied by fMRI scanning (61 procedures) and intraoperative cortical brain mapping under general anesthesia. The fMRI data obtained were analyzed with the Statistical Parametric Mapping 99 software, with an initial analysis threshold corresponding to P < 0.001. Subsequently, the fMRI data were registered in a frameless stereotactic neuronavigational device and correlated to brain mapping.
Correspondence between fMRI-activated areas and cortical mapping in primary motor areas was good in 28 patients (87%), although fMRI-activated areas were highly dependent on the choice of paradigms and analysis thresholds. Primary sensory- and secondary motor-activated areas were not correlated to cortical brain mapping. Functional mislocalization as a result of insufficient correction of the echo-planar distortion was identified in four patients (13%). Analysis thresholds (from P < 0.0001 to P < 10(-12)) more restrictive than the initial threshold (P < 0.001) had to be used in 25 of the 28 patients studied, so that fMRI motor data could be matched to cortical mapping spatial data. These analysis thresholds were not predictable preoperatively. Maximal tumor resection was accomplished in all patients with brain tumors. Chronic motor cortex electrode placement was successful in each patient (significant pain relief >50% on the visual analog pain scale).
In brain tumor surgery, fMRI data are helpful in surgical planning and guiding intraoperative brain mapping. The registration of fMRI data in anatomic slices or in the frameless stereotactic neuronavigational device, however, remained a potential source of functional mislocalization. Electrode placement for chronic motor cortex stimulation is a good indication to use fMRI data registered in a neuronavigational system and could replace somatosensory evoked potentials in detection of the central sulcus.
本文旨在分析在用于脑肿瘤或疼痛手术（慢性运动皮层刺激）的无框架立体定向设备中使用功能磁共振成像（fMRI）数据所产生的技术和方法学问题。
共有32名受试者接受研究，其中26名用于脑肿瘤手术，6名用于慢性运动皮层刺激，均在全身麻醉下进行fMRI扫描（61次操作）和术中皮层脑图谱绘制。使用统计参数映射99软件对获得的fMRI数据进行分析，初始分析阈值对应P < 0.001。随后，将fMRI数据注册到无框架立体定向神经导航设备中，并与脑图谱相关联。
28例患者（87%）的fMRI激活区域与初级运动区的皮层图谱之间对应良好，尽管fMRI激活区域高度依赖于范式的选择和分析阈值。初级感觉和次级运动激活区域与皮层脑图谱不相关。4例患者（13%）因回波平面失真校正不足而出现功能定位错误。在所研究的28例患者中的25例中，必须使用比初始阈值（P < 0.001）更严格的分析阈值（从P < 0.0001到P < 10^(-12)），以便fMRI运动数据能够与皮层图谱空间数据匹配。这些分析阈值术前无法预测。所有脑肿瘤患者均实现了最大程度的肿瘤切除。每位患者的慢性运动皮层电极放置均成功（视觉模拟疼痛量表上疼痛显著缓解>50%）。
在脑肿瘤手术中，fMRI数据有助于手术规划和指导术中脑图谱绘制。然而，将fMRI数据注册到解剖切片或无框架立体定向神经导航设备中仍然是功能定位错误的潜在来源。慢性运动皮层刺激的电极放置是使用注册在神经导航系统中的fMRI数据的良好指征，并且在检测中央沟方面可以替代体感诱发电位。
