Functional magnetic resonance imaging of motor and language for preoperative planning of neurosurgical procedures adjacent to functional areas

• fMRI is a reliable method for identification of functional brain areas prior to brain surgery.
• fMRI provides additional information to improve preoperative planning, surgical strategy and decision making with patients.
• fMRI is helpful for surgeons and patients as well to discuss the operation risk and the alternative of awake surgery.
• Limitations of fMRI are bigger for preoperative language mapping.

ObjectiveFunctional magnetic resonance imaging (fMRI) for motor and language mapping is used for presurgical planning. This study aimed to evaluate the value of fMRI in clinical routine for preoperative planning of brain surgery adjacent to functional brain areas.MethodsThirty-seven consecutive patients with brain lesions adjacent to sensomotor and/or language functional areas underwent fMRI prior to planned brain surgery on a 3 T MRI scanner for identification of motor in all and language functional areas in 29 patients. Analysis software installed on the MRI console was used for rapid image analysis and direct visualization. All fMRI results were analyzed according to the use for preoperative planning.ResultsfMRI data analysis and visualization was possible in less than 10 min. In 35 patients fMRI of motor cortex and in 25 patients fMRI of language could be performed due to the patient's compliance. In 34 patients motor activity could be clearly identified in the precentral gyrus. The dominant hemisphere could be identified clearly in 22 cases. In 18 patients direct anatomical correlation of the activity maps to the speech area of Broca and/or Wernicke could be made. Resection surgery was performed in all patients. 11 patients underwent awake surgery with intraoperative cortical stimulation.ConclusionfMRI for clinical routine is a reliable and rapid method for identification of functional brain areas prior to brain surgery adjacent to functional areas. This method allows direct monitoring of the data quality and visualization without being time consuming. Knowledge about the relation of functional areas to the brain lesions improves the preoperative planning, the operation strategy and decision making with patients.