Application of neuronavigation multimodal fusing combining intraoperative electrophysiological techniques in the tumor surgery of brain motor areas

Abstract

Objective To investigate the clinical application value of neuronavigation multimodal fusing (DTI and BOLD) combining intraoperative electrophysiological monitoring techniques in tumor surgery of brain motor areas. Methods From October 2014 to January 2015, 20 right-handed patients whose lesions were located near the brain motor areas admitted to the Department of Neurosurgery, Changhai Hospital, the Second Military Medical University were analyzed retrospectively. The patients received preoperative magnetic resonance diffusion tensor imaging (DTI) and blood oxygen level dependent-functional magnetic resonance imaging (BOLD-fMRI) examinations. The original data of white matter fiber tracts and BOLD data were obtained. The neural navigation multimodal fusion DTI, BOLD, anatomical images [brain magnetic resonance venography (MRV), if necessary], and the three-dimensional reconstruction were performed. The microsurgery was performed under the assisted navigation during the operation, and the anterior central gyrus, central sulcus, posterior central gyrus, and subcortical tracts were determined under the neural electrophysiological monitoring. Results Of the 20 patients with motor area tumor, the lesions of 17 patients were resected, and 3 were resected subtotally. The intraoperative electrophysiological results were consistent with the preoperative DTI and BOLD reconstructed results. Postoperative pathological results: 9 patients had glioma (low-level 4 and high-level 5) and 11 had meningioma. The postoperative muscle strength of 15 patients did not have any change, 5 had transient hemiparesis. DTI showed that there was no obvious damage to the nerve tracts at 24 h after procedure. After being followed up for 2 weeks to 3 months, the patients were able to take care of themselves. Conclusions Neuronavigation multimodal fusing can accurately locate the motor function areas, and combined electrophysiological monitoring can compensate for the errors caused by the drift of the neural navigation. The peripheral adjacent tracks and functional areas were protected real timely during the operation in order to reduce the postoperative neurological dysfunction. The tumors were resected in a maximum degree within the safe range. In addition, the intraoperative electrophysiological monitoring and early postoperative DTI examination can predict the postoperative muscle strength and improve the postoperative quality of life of patients. Key words: Neuronavigation; Diffusion tensor imaging; Functional magnetic resonance imaging; Electrophysiology; Microsurgery