Intra-operative recording of direct cortical stimulation in low-grade gliomas using neuro-navigation for cross-validation of pre-operative motor and language functional MRI: Feasibility and initial pilot data

DJ Coope, K Karabatsou, S Green, G Wall, J Bambrough

Research output: Contribution to conferenceOther

Abstract

INTRODUCTION: Cortical mapping can maximize tumour resection whilst preserving eloquent cortex in glioma surgery. Direct cortical stimulation (DCS) during awake craniotomy remains the current “gold standard”. Functional MRI (fMRI) presents an alternative but raises theoretical concerns relating to neurovascular de-coupling close to the tumour. Comparative studies are limited by difficulties in accurately recording the locations at which DCS is performed. We present the initial evaluation of a system to facilitate the use of commercial neuro-navigation technology to record DCS outcomes. METHOD: Three patients underwent pre-operative neuropsychological assessment and motor / language fMRI on a Phillips 3T Achieva scanner. fMRI data was available for surgical planning but the surgeon was blinded during DCS to minimise bias. During awake craniotomy, a bipolar cortical stimulator was tracked using a BrainLab VectorVision system networked with a laptop using the VVLink interface. DCS was performed whilst motor and language function was assessed by a neuropsychologist and outcomes recorded by the surgeon using a panel of footswitches to control a custom logging module implemented within the Slicer software package. RESULTS: A mean of 103 unique data-points were recorded (range 73-136) with minimal additional operative time. Mean number of areas tested for language function at the highest required stimulation level was 51 (range 26-74). Mean distance to the nearest fMRI activation did not differ between positive and negative DCS (6.8 vs 6.1mm). CONCLUSION: Use of fMRI/neuro-navigation to record DCS outcomes is feasible and enables detailed study of the correlation between pre- and intra-operative techniques for cortical mapping.
Original languageEnglish
DOIs
Publication statusPublished - 2012
EventBritish Neuro-Oncology Society - Manchester, UK
Duration: 27 Jun 201229 Jun 2012

Conference

ConferenceBritish Neuro-Oncology Society
CityManchester, UK
Period27/06/1229/06/12

Keywords

  • Direct Cortical Stimulation
  • fMRI
  • Awake Craniotomy

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