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Awake Mapping and Pitfalls of Functional MRI

October 07, 2015


This short video illustrates the shortcomings and pitfalls in patient selection and also the drawbacks of functional MRI in determining functional cortices. This is a 42 year-old female who presented with seizures. MRI evaluation demonstrated a large posterior frontal glioma infiltrating the motor cortex. Here's the anatomical central sulcus. Here's the anatomical precentral gyrus. I, again, believe that the motor cortex is completely infiltrated by the tumor. On a sagittal T2 MRI image you can see the marginal sulcus, the motor cortex is filled with tumor. Minimal enhancement is apparent. This is most likely a grade three or anaplastic glioma. However, in this case, functional MRI localized the motor function somewhat beyond the boundaries of the tumor. Again, concluding that the motor function has been displaced. Similar findings could be estimated using a satchel image. Due to findings on the the MRI, a right posterior frontal craniotomy was completed. Interoperative MRI navigation estimated the borders of the tumor as marked using the green suture. Cortical mapping was used. You can see the hands, leg and hip area. The hand area was very much localized to the center of the tumor. Further stimulation in this case led to intra-operative motor seizures as you can see here. The seizures affected the left upper extremity. Lower stimulation parameters were used for further mapping. Again, confirming the location of the motor function just over the area of the tumor. Due to the location of the tumor in an overlying function, I felt the resection would be risky and therefore the operation was abandoned to avoid any further injury. Here you can see again, the motor seizure activity caused by cortical stimulation. Thank you.

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