Department of Neurosurgery and Gamma Knife Radiosurgery, P. D. Hinduja Hospital and Medical Research Centre, V. S. Marg, Mahim, Mumbai, Maharashtra, India.
Department of Neurology, P. D. Hinduja Hospital and Medical Research Centre, V. S. Marg, Mahim, Mumbai, Maharashtra, India.
Neurol India. 2022 Jul-Aug;70(4):1534-1539. doi: 10.4103/0028-3886.355146.
Direct Cortical Stimulation (DCS) represents the gold standard for mapping of eloquent brain cortex. However, DCS is an invasive and time-consuming procedure. fMRI has become a useful tool to delineate motor and sensory eloquent cortex from the areas of planned neurosurgical resection. In our study, we will be studying the reliability of preoperative imaging when compared with the intraoperative DCS.
The aim of this study was to assess the reliability of fMRI by comparing it with DCS.
Thirty patients with eloquent cortex lesions were admitted. Preoperative fMRI sequences were loaded into a neuro-navigational system. Intraoperative motor mapping was done by DCS. The location of all cortical stimulated points was correlated with the cortical functional structures. Based on it, specificity, sensitivity, positive predictive value, negative predictive value of fMRI was calculated. Preoperative and postoperative Karnofsky score and MRC grading was then noted.
Concordance between fMRI and DCS was noted in 26 cases. Overall mean sensitivity, specificity, positive and negative predictive value of fMRI as compared to DCS was 95%, 92.48%, 85.56%, and 96.08%, respectively. Preoperative and Postoperative Karnofsky score stayed same in most of the cases [25/30].
DCS remains the gold standard for mapping eloquent cortex in-spite of its invasiveness, side effects such as seizures and cost concerns. Although fMRI cannot replace DCS, it can guide and increase the efficacy in resection, select high-risk patients for intraoperative monitoring, help in preoperative stratification of risk counseling and preservation of neurological status in eloquent brain lesions.
直接皮层刺激（DCS）是语言脑皮层定位的金标准。然而，DCS 是一种侵入性和耗时的程序。fMRI 已成为从计划神经外科切除区域描绘运动和感觉语言皮层的有用工具。在我们的研究中，我们将研究术前成像与术中 DCS 相比的可靠性。
本研究旨在通过与 DCS 比较来评估 fMRI 的可靠性。
收治了 30 名语言皮层病变患者。将术前 fMRI 序列加载到神经导航系统中。通过 DCS 进行术中运动映射。将所有皮层刺激点的位置与皮层功能结构相关联。根据这些，计算 fMRI 的特异性、敏感性、阳性预测值和阴性预测值。然后记录术前和术后卡诺夫斯基评分和 MRC 分级。
在 26 例中观察到 fMRI 与 DCS 之间的一致性。与 DCS 相比，fMRI 的总体平均敏感性、特异性、阳性和阴性预测值分别为 95%、92.48%、85.56%和 96.08%。在大多数情况下，术前和术后卡诺夫斯基评分保持不变[30/30]。
尽管 DCS 具有侵袭性、癫痫发作等副作用和成本问题，但它仍然是语言皮层定位的金标准。虽然 fMRI 不能替代 DCS，但它可以指导和提高切除的效果，选择需要术中监测的高危患者，帮助在术前进行风险咨询和保留语言脑病变的神经状态的分层。
