1097-0150/asset/cover.gif?v=1&s=374b3c0e9ae59efc78fa92ba65770d38a3c773c8 "Computer Aided Surgery")
This article is based on presentations at the CARS 2001 meeting in Berlin, June 2001, and at the CAS 2001 workshop in Nuremberg, November 2001.
Clinical Paper
Comparison of functional brain PET images and intraoperative brain-mapping data using image-guided surgery†
Article first published online: 28 APR 2003
DOI: 10.1002/igs.10060
Copyright © 2003 Wiley-Liss, Inc.
Additional Information
How to Cite
Sobottka, S.B., Bredow, J., Beuthien-Baumann, B., Reiss, G., Schackert, G. and Steinmeier, R. (2002), Comparison of functional brain PET images and intraoperative brain-mapping data using image-guided surgery. Comput. Aided Surg., 7: 317–325. doi: 10.1002/igs.10060
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Publication History
- Issue published online: 28 APR 2003
- Article first published online: 28 APR 2003
- Manuscript Accepted: 14 JAN 2003
- Manuscript Received: 28 FEB 2002
- Abstract
- Article
- References
- Cited By
Keywords:
- functional brain imaging and mapping;
- image-guided surgery;
- image fusion;
- speech monitoring
Abstract
Objective
Knowledge about the spatial localization of eloquent brain areas is essential for resecting lesions in the vicinity of these areas. The classical approach is to perform surgery on the awake patient under local anesthesia using brain-mapping techniques. As an alternative, the location of eloquent areas can be visualized by preoperative functional brain-imaging techniques, for example, positron emission tomography (PET), functional magnetic resonance imaging (fMRI), or magnetoencephalography (MEG). Using functional activation PET, both methods were combined by integration into a frameless navigation system (BrainLAB) and used to map speech-eloquent areas.
Patients and Methods
Speech-eloquent areas were localized preoperatively in seven patients with a left-sided glioma using 2-[18F]-2-desoxy-D-glucose PET. Patients were scanned under silence conditions (i.e., with the patient remaining silent in a sound-proof cabin), and speech was activated using a verb-generation paradigm. The PET data were transferred to the neuronavigation workstation and matched with a preoperative 3D-MRI using an automatic image-fusion algorithm. Intraoperative speech localization was performed using brain-mapping techniques under local anesthesia with bipolar cortical stimulation. The stimulator position was mapped into the MRI/PET data set by neuronavigational tracking of the instrument.
Results
Functional PET images were integrated into the MRI-based neuronavigational system and could be transferred exactly to the operative field. By the additional integration of cortical stimulation, intraoperative electrophysiological findings can be directly compared with preoperative functional images. Seven patients with left-sided glioma were operated on using this protocol, confirming the technical feasibility. In three of seven patients, preoperative PET findings were not supported by intraoperative mapping.
Conclusions
This matching and mapping technique is suitable for monitoring eloquent speech areas during surgical resection of extensive left-sided low-grade gliomas, allowing a direct comparison between intraoperative electrophysiological brain mapping and preoperative functional brain-imaging findings. The sensitivity and specificity of functional imaging techniques can now be evaluated by reconciling the data with the intraoperative stimulation results. Comp Aid Surg 7:317–325 (2002). © 2003 Wiley-Liss, Inc.