Functional magnetic resonance mapping of sensory motor cortex for image-guided neurosurgical intervention

Purpose: This paper describes the potentials of functional magnetic resonance imaging (fMRI) to map sensory motor cortex in patients with mass lesions near primary motor cortex and to guide neurosurgical procedures located close to eloquent brain regions. Material and Methods: 7 patients with mass lesions near the central sulcus and 10 healthy volunteers were studied using a blood oxygenation level dependent 2D multislice multishot T2* weighted gradient echo EPI sequence on a 1.5T Phillips Gyroscan during alternating epochs of rest and motor activation of hand, foot and tongue. Sites of neuronal activation were identified by statistical analysis of the signal time course using Kolmogorov Smirnov statistics. Results: Neuronal activation following motor tasks consistently localised to the contralateral precentral gyrus and the supplementary motor area, even in the presence of local brain pathology. Additionally we could observe activation in primary sensory areas (postcentral gyrus) and supplementary motor area (SMA) in some cases. Conclusion. fMRI is capable of mapping sensory motor cortex even in the presence of distorting brain lesions. Since this information will provide valuable information to the neurosurgeon during pre-operative planning, we consider this method for neurosurgical navigation a valuable tool in the routine diagnostic of intracerebral interventions.