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Brain surface reformatted imaging (BSRI) for intraoperative neuronavigation in brain tumor surgery

  • Clinical Article - Neurosurgical Techniques
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Abstract

Background

For safe resection of lesions situated in or near eloquent brain regions, determination of their spatial and functional relationship is crucial. Since functional magnetic resonance imaging and intraoperative neurophysiological mapping are not available in all neurosurgical departments, we aimed to evaluate brain surface reformatted imaging (BSRI) as an additional display mode for neuronavigation.

Methods

Eight patients suffering from perirolandic tumors were preoperatively studied with MRI and navigated transcranial magnetic stimulation (nTMS). Afterwards, the MRI was automatically transformed into BSR images in neuronavigation software (Brainlab, Brainlab AG, Feldkirchen, Germany). One experienced neuroradiologist, one experienced neurosurgeon, and two residents determined hand representation areas ipsilateral to each tumor on two-dimensional (2D) MR images and on BSR images. All results were compared to results from intraoperative direct cortical mapping of the hand motor cortex and to preoperative nTMS results.

Results

Findings from nTMS and intraoperative direct cortical mapping of the hand motor cortex were congruent in all cases. Hand representation areas were correctly determined on BSR images in 81.3 % and on 2D-MR images in 93.75 % (p = 0.26). In a subgroup analysis, experienced observers showed more familiarity with BSRI than residents (96.9 vs. 84.4 % correct results, p = 0.19), with an equal error rate for 2D-MRI. The time required to define hand representation areas was significantly shorter using BSRI than using standard MRI (mean 27.4 vs. 40.4 s, p = 0.04).

Conclusions

With BSRI, a new method for neuronavigation is now available, allowing fast and easy intraoperative localization of distinct brain regions.

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Conflict of interest

This work was not supported by any grants. Mrs. Heindl works as a Senior Clinical Consultant for Brainlab. Dr. Forster has served as a speaker for Nexstim but is not a contracted consultant. Dr. Senft has served as a speaker for Brainlab and Medtronic Navigation. The other authors have no personal financial or institutional interests in any of the devices, materials, or methods described in this article. No funding has been received for this work.

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Correspondence to Marie-Therese Forster.

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Comments

The authors describe the implementation of the navigated transcranial magnetic stimulation into a neuro-navigation model by creating a brain surface reformatted imaging. They conclude in a very small series of eight patients in whom this technique was used that the accuracy of BSRI by nTMS is as good as intra-operative cortical mapping or preoperative assessment by anatomical landmark. I believe this paper has a potential value to introduce another technique for improvement of eloquent cortex mapping during surgery of highly eloquent lesions. However, the technique per se is not user-friendly, and I can say that most modern neurosurgical services would not need to use this adjunct as there are more practical and reliable techniques such as awake craniotomy, intra-operative monitoring, and/or even implementation of functional MRI into neuronavigation on a 3D model.

Amir Dehdashti

NY, USA

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Forster, MT., Heindl, N., Hattingen, E. et al. Brain surface reformatted imaging (BSRI) for intraoperative neuronavigation in brain tumor surgery. Acta Neurochir 157, 265–274 (2015). https://doi.org/10.1007/s00701-014-2316-1

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  • DOI: https://doi.org/10.1007/s00701-014-2316-1

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