Abstract
Functional Magnetic Resonance Imaging (fMRI) is a presurgical planning technique used to localize functional cortex so as to maximize resection of diseased tissue and avoid viable tissue. In this retrospective study, we examined differences in morbidity and mortality of brain tumor patients who received preoperative fMRI in comparison to those who did not. Brain tumor patients (n=206) were selected from a retrospective review of neurosurgical case logs from 2001-2009 at the University of Wisconsin-Madison. Univariate analysis showed improved mortality in the fMRI group and the fMRI+Electrical Cortical Stimulation Mapping (ECM) group compared to the No-fMRI group. Multivariate analyses showed improved mortality of the fMRI group and the fMRI+ECM group compared to the No-fMRI group, with age and tumor grade being the most significant influencers. Overall, the fMRI group showed survival benefits at 3 years; twice that of the No-fMRI group. Furthermore, patients with high-grade tumors showed significant survival benefits in the fMRI group, while patients with low-grade tumors did not (controlling for age and ECM). There was also a significant difference in the two groups with respect to morbidity, with patients receiving fMRI showing improved outcomes in the motor and language domains. This study analyzing a large retrospective series of brain tumor patients with and without the use of fMRI in the preoperative planning has resulted in improved mortality and morbidity outcomes with the use of fMRI. These results point to the importance of incorporating fMRI in presurgical planning in the clinical management of patients with brain tumors.
Highlights
The long-term morbidity and mortality of brain tumor patients undergoing surgical resection is dependent on the extentof tumor resection[1,2,3] and the identification and avoidance of nearby critical functional brain regions such as motor and language networks.[4,5] anatomical landmarks are frequently used to localize functional brain regions, the mass effect and growth of tumors frequently distort normal anatomy and may cause considerable reorganization of nearby functional cortex.[6]
Univariate analysis showed improved mortality in the Functional Magnetic Resonance Imaging (fMRI) group and the fMRI +Electrical Cortical Stimulation Mapping (ECM) group compared to the No-fMRI group
Multivariate analyses showed improved mortality of the fMRI group and the fMRI+electrical cortical stimulation mapping (ECM) group compared to the No-fMRI group, with age and tumor grade being the most significant influencers
Summary
The long-term morbidity and mortality of brain tumor patients undergoing surgical resection is dependent on the extentof tumor resection[1,2,3] and the identification and avoidance of nearby critical functional brain regions such as motor and language networks.[4,5] anatomical landmarks are frequently used to localize functional brain regions, the mass effect and growth of tumors frequently distort normal anatomy and may cause considerable reorganization of nearby functional cortex.[6]. To our knowledge, there is no study to date comparing the morbidity and mortality of surgical patients that undergo preop fMRI with those that do not undergo preop fMRI. In this retrospective study, we report improvement in morbidity and mortality of brain tumor patients who underwent preoperative functional imaging than those who did not. Functional Magnetic Resonance Imaging (fMRI) is a presurgical planning technique used to localize functional cortex so as to maximize resection of diseased tissue and avoid viable tissue In this retrospective study, we examined differences in morbidity and mortality of brain tumor patients who received preoperative fMRI in comparison to those who did not
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