Schulder M, Maldjian J A, Liu W C, Holodny A I, Kalnin A T, Mun I K, Carmel P W
Section of Neurosurgery, New Jersey Medical School, Newark, USA.
J Neurosurg. 1998 Sep;89(3):412-8. doi: 10.3171/jns.1998.89.3.0412.
The purpose of this study was to evaluate the efficacy of noninvasive preoperative functional imaging data used in an interactive fashion in the operating room. The authors describe a method of registering preoperative functional magnetic resonance (fMR) imaging localization of sensorimotor cortex with a frameless stereotactic surgical navigation device.
The day before surgery, patients underwent blood oxygen level-dependent fMR imaging while performing a finger-tapping motor paradigm. Immediately afterward an anatomical stereotactic MR image was acquired. Raw fMR imaging data were analyzed offline at a separate workstation, and the resulting functional maps were registered to a high-resolution anatomical scan. The fused functional-anatomical images were then downloaded onto a surgical navigation computer via an ethernet connection. At surgery, the brain was exposed in the standard fashion, and the sensorimotor cortex was identified by direct cortical stimulation, the use of somatosensory evoked potentials, or both. This localization was then compared with that predicted by the registered fMR study. Thirteen procedures were performed in 12 patients. The mean registration error was 2.2 mm. The predicted location of motor and/or sensory cortex matched that found on intraoperative mapping in all 12 patients tested. Maximal tumor resection was accomplished in each case and no new permanent neurological deficits resulted.
Compared with conventional brain mapping techniques, fMR image-guided surgery may allow for smaller brain exposures, localization of the language cortex with the patient under general anesthesia, and the mapping of multiple functional sites. The scanning equipment used in this method may be more readily available than for other functional imaging techniques such as positron emission tomography or magnetoencephalography.
本研究的目的是评估以交互方式在手术室中使用的无创术前功能成像数据的疗效。作者描述了一种将术前感觉运动皮层的功能磁共振（fMR）成像定位与无框架立体定向手术导航设备进行配准的方法。
手术前一天，患者在执行手指敲击运动范式时接受血氧水平依赖性功能磁共振成像检查。随后立即获取解剖立体定向磁共振图像。原始功能磁共振成像数据在单独的工作站进行离线分析，所得功能图谱与高分辨率解剖扫描进行配准。然后通过以太网连接将融合的功能-解剖图像下载到手术导航计算机上。在手术中，以标准方式暴露大脑，通过直接皮层刺激、体感诱发电位或两者结合来识别感觉运动皮层。然后将该定位与注册功能磁共振研究预测的定位进行比较。对12例患者进行了13次手术。平均配准误差为2.2毫米。在所有12例接受测试的患者中，运动和/或感觉皮层的预测位置与术中测绘结果相符。每例均实现了最大程度的肿瘤切除，且未出现新的永久性神经功能缺损。
与传统的脑图谱技术相比，功能磁共振成像引导的手术可能允许更小范围的脑暴露、在全身麻醉下对语言皮层进行定位以及对多个功能位点进行测绘。该方法中使用的扫描设备可能比正电子发射断层扫描或脑磁图等其他功能成像技术更容易获得。
