Case Series of Applications of Resting State Functional MRI in Brain Tumor Surgery: A Novel Technique.

The extent of resection for brain tumors is a critical factor in determining the oncologic outcome for a patient. However, a balance between preservation of neurological function and maximal resection is essential for true benefit. Functional magnetic resonance imaging (fMRI) is one of the approaches that augments the neurosurgeon's ability to attain maximal safe resection by providing preoperative mapping. It may not be possible to perform awake craniotomy with intraoperative localization by direct cortical stimulation in all patients, such as children and those with neurocognitive impairment. Task-based fMRI may have limited value in these cases due to low patient cooperability.  In this article we present in a case-based format, the various clinical scenarios where resting state fMRI (rs-fMRI) can be helpful in guiding neurosurgical resection. rs-fMRI of the patients has been acquired on Philips 1.5 T system. Seed voxel method has been used for processing and analysis.  rs-fMRI does not require active patient cooperation to generate useful information and thus can be a promising tool in patients unable to cooperate for task-based studies.