Application Of FMRI And DTI Combined With Neuronavigation And Direct Electrical Stimulation During Surgery Of Cerebral Tumors In Eloquent Areas

Objective：To investigate the experiences of the application of fMRI and DTI combinedwith direct electrical stimulation and neuronavigation in the surgery of tumor ineloquent areas.Methods：Twenty patients with brain tumor involving motor areas were included.11malesand9females，aged from11to66years(mean±SD，43.6±15.90years)．All imagingstudies were performed on a3．0T SIEMENS magnetic resonance system, MRI scansfor DTI and navigation pre—operation． Corticospinal tract was reconstructed tolocalize the motor area． Seed points were set in the cerebral peduncle of themidbrain and the ventral of the pons．Corticospinal tract(CST) was reconstructed byfiber assignment continuous tracking．Reconstructed CST was fused with the threedimension anatomical image． The relationship between cerebral motor cortex,pyramid tract and tumor the were analyzed． The reasonable surgical plain wasestablished according to the information．After locating on eloquent areas by directelectrical stimulation and neuronavigation, tumor resection was performed by thesame surgeon under microscope．Results：BOLD-fMRI,DTl were performed successfully in14patients, only to got themotor cortex image in4cases, pyramidal tract reconstruction were obtained due tohand movement disorder in2patients; motor cortex was located successfully byintraoperative cortical electrical stimulation in15cases (positive target of1to7), and4cases failed,1case of termination due to seizures in the surgery (9patients withsupratentorial tumors were absolutely evaluated with fMRI and DTI and ECS to mapthe eloquent areas,11patients with tumors were incompletely evaluated with thosetechniques). Tumor was totally resected in17cases，and was subtotally resected in3cases.They were astrocytoma in9cases，hemangioma in3cases，oligodendroglioma in2cases， meningioma in2cases，vascular malformation in1case，Post-radiationnecrosis in l case．KPS score Was81.50+／-16.31before surgery,86.50+／-15.85two weeks after surgery,and95.50+／-11.46three months after surgery．There was asignificant difference between KPS score2w／3m after surgery and KPS scorebefore surgery(p<0.05)statistically．Post-operation follow—up ranges from3m to18m，with an average of8.80+／-5.18m，tumor recurred in4cases，two patients diedof multiform glioblastma recurrence．Conelusion：Application of fMRI and DTI combined with direct electrical stimulation andneuronavigation will provide very useful information, it can ascertain the relationshipbetween eloquent area and the tumor, improve the accuracy in the surgery,andeffectively protect the brain function in the tumor patients.