The Application Of Functional MRI In The Intracranial Tumor Resection To Avoid The Trauma Of Important Functional Area And Structure

Objective:Using functional magnetic resonance imaging technology to show the relationship among the important functional area of the brain,fiber bundles and the tumor which lead to the lesion of the cerebral cortex motor area,we provided functional anatomy basis in the preoperative surgical planning to avoid the functional and structural damage in operation. Materials and Methods:Conventional MRI were used to establish the location,size,blood supply of tumor,the extent of peritumoral edema and the relationship between the adjacent structure and the tumor.There were total 23 cases with intracranial tumor,which leaded to the lesion of the cerebral cortex motor area.They were all right-handed.12 cases using conventional surgery were the control group(eight cases of glioma,3 cases of meningioma,1 case of brain metastases),eight cases of men,four cases of women;the average of 42 years old. The other patients were the experimental group(six cases of glioma,2 cases of meningioma, 2 cases of brain metastases,cavernous angioma 1 case),seven cases of men,four cases of women,the average of 45 years old.The patients had varying degrees of physical activity limitation,fatigue,hypomyotonia and so on.GE MRI 1.5T was used to give all patients the conventional and enhancement scan before the surgery.Besides,the experimental group would be given the extra functional magnetic resonance imaging(BOLD-fMRI and DTI).The data of BOLD-fMRI was post-processed by SPM2 software to analyse the activation strength and range of motor functional areas.The data of diffusion tensor imaging(DTI) was post-processed by diffusion TENSOR Visualizer(DTV.II.SR) software to analyse the relationship between corticospinal tract and the tumor,and the change between pre-operative and post-operative.The vision of motor area and the relationship between corticospinal tract and tumor could provide the important functional anatomy basis to formulate pre-operative program,resect the tumor and protect the motor area and corticospinal tract as much as possible.The experimental group reviewed after two weeks,repeated the above-mentioned order completely.All patients needed to do the test of muscle strength ratings and KPS at one week before surgery,two weeks after surgery respectively.Then we used SPSS 11.5 software to carry out paired-simples T test between 1 week before surgery and two weeks after the operation,for the activation intensity,range of motor functional area and ipsilateral corticospinal tract fibers of the patients in the experimental group.At the end,we carried out the sum test between the control group and the experimental group for the changes in muscle strength and changes in KPS scores in pre-operative and post-operative,when p＜0.05,the difference between these groups had statistical significances.Results:DT-FT experimental group showed that in the experimental group the number of corticospinal tract fibers of 9 cases increased after operation.Before operation,the average number of corticospinal tract fibers was 33±9.788,the numerical of corticospinal tract fibers: s=-0.573,k=0.322;After operation,the average number of corticospinal tract fibers was 45.273±3.778,the numerical of corticospinal tract fibers:s=0.093,k=-1.075.Self-control t-test were used in the corticospinal tract fibers of preoperative and postoperative,t=-4.533, p=0.001,p＜0.05.They had statistical significances between the numerical ofcorticospinal tract fibers with preoperative and post-operative.BOLD-fMRI results showed that the activation intensity of motion domain of the experimental group patients were higher than the preoperative.The activation extent of 9 cases increased than the preoperative.The average of the activation intensity with preoperative was 5.456±2.746,The average of the activation intensity with post-operative was 7.456±4.441.Self-control t-test were used in the activation intensity of preoperative and postoperative,t=-2.894,p=0.016,(p＜0.05).They had statistical significances.Self-control t-test were used in the extent of activation of the preoperative and the postoperative,t=-4.039,p=0.002.They had statistical significances. Rank-sum test were used between the muscle strength changes of the control and the experimental group,z=-2.426,p=0.015(p＜0.05).The muscle strength changes and the recovery extent of the muscle strength of the experimental group more than the control group. Rank-sum test were used in the KPS scores changes between the control and the experimental group,z=-2.356,p=0.018(p＜0.05).They had statistical significances.Therefore.the experimental group could be better protect the structure and important functional areas than the control in operations.Conclusions:DT-FT could better show the relationship between tumor and the brain important fiber structure;BOLD-fMRI could identify the relationship between the tumor and motion domains.Especially in pathological cases,BOLD-fMRI could show the location change of functional areas and provide reliable functional anatomy basis for the operation.