Real-time 3T fMRI data of brain tumour patients for intra-operative localization of primary motor areas.

INTRODUCTION: In patients with tumours in or near the motor cortex reliable intra-operative identification of the precentral gyrus can be difficult due to anatomical dislocation. Maps of functional magnetic resonance imaging (fMRI) based on the blood oxygen level dependent (BOLD) effect are used to localize eloquent functional areas of the brain but require postprocessing for reduction of false positive activations. We set the focus of this study on the evaluation of feasibility and clinical usefulness of using real-time fMRI t-maps without postprocessing for pre-operative planning and intra-operative localization of functional motor areas. METHODS: Real-time fMRI t-maps from a 3-T MRI scanner were co-registered with MRI data. Ten patients were operated under general anaesthesia using 3D neuronavigation with integrated real-time fMRI t-maps. Surgical and functional outcome was compared to results of 12 patients who previously underwent wake surgeries. RESULTS: Good neurological outcome was achieved in all treated patients. Main activation clusters on fMRI real-time maps were easily identified. Co-registered real-time fMRI data without additional postprocessing were useful in planning the surgical approach. However, due to brain shift and large voxel size of BOLD contrast signals on t-maps exact localization of borders between tumours and functional areas was not possible intra-operatively. CONCLUSION: Our method is very simple to use and effective in guiding the neurosurgeon safely through minimally invasive craniotomies to tumours in eloquent areas without setting lesions to functional areas. Furthermore, the neurosurgeon is more independent when tumour location requires acquisition of fMRI data for pre-operative planning and intra-operative navigation.

Cavernous malformation of the internal auditory canal.

Cavernous malformations of the internal auditory canal are a rare clinical entity that, however, should be considered in the differential diagnosis of intracanalicular masses. Even though this type of malformation is usually associated with an evident gadolinium enhancement at MR examination, in some patients, like in this case, the signal characteristics may be not sufficiently specific to allow the correct preoperative diagnosis. Nevertheless, the clinical history, in particular, a rapid onset of cranial nerve deficits, lead to the suspicion of a vascular malformation.