Integrated image- and function-guided surgery in eloquent cortex: a technique report
James P. O’Shea, Stephen Whalen, Daniel M. Branco, Nicole M. Petrovich, Kyle E. Knierim, Alexandra J. Golby
The ability to effectively identify eloquent cortex in close proximity to brain
tumours is a critical component of surgical planning prior to resection. The
use of electrocortical stimulation testing (ECS) during awake neurosurgical
procedures remains the gold standard for mapping functional areas, yet the
preoperative use of non-invasive brain imaging techniques such as fMRI are
gaining popularity as supplemental surgical planning tools. In addition, the
intraoperative three-dimensional display of fMRI findings co-registered to
structural imaging data maximizes the utility of the preoperative mapping
for the surgeon. Advances in these techniques have the potential to limit the
size and duration of craniotomies as well as the strain placed on the patient,
but more research accurately demonstrating their efficacy is required. In
this paper, we demonstrate the integration of preoperative fMRI within a
neuronavigation system to aid in surgical planning, as well as the integration
of these fMRI data with intraoperative ECS mapping results into a threedimensional
dataset for the purpose of cross-validation.
Left: Offline view from the 3D Slicer application of the data
for patient 4, including fMRI activation from the active left-hand
motor task (blue). Positive ECS sites are depicted in red, negative
ECS sites are green and electrodes are yellow. The tumour is not
visible in this rendering because the cortical surface is opaque.
Right: Offline view from the 3D Slicer application of the
data for patient 4, with only the local maximum of the fMRI
activation (blue) displayed from the active left-hand motor task.
Because the local maximum was several millimetres below the
cortical surface, the model of the cortical surface was rendered
to be transparent, revealing the lesion (pink mass). The positive
ECS sites are depicted in red, negative ECS sites in green and
electrodes in yellow.
Integrated image- and function-guided surgery in eloquent cortex: a technique report
James P. O’Shea, Stephen Whalen, Daniel M. Branco, Nicole M. Petrovich, Kyle E. Knierim, Alexandra J. Golby
International Journal of Medical Robotics and Computer-Assisted Surgery
2006; 2: 75-83.