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Neurosurgery

Alexandra Golby, M.D. Neurosurgery. Functional imaging and electrocorticography-guided surgery in eloquent cortex. Surgical resection is most effective initial therapy for a variety of brain tumors

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Neurosurgery

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  1. Alexandra Golby, M.D. Neurosurgery

  2. Functional imaging and electrocorticography-guided surgery in eloquent cortex • Surgical resection is most effective initial therapy for a variety of brain tumors • Maximal surgical excision relieves mass effect, decreases tumor burden, decreases incidence of seizures and may prolong time to recurrence and survival • Defining limits of the resection difficult due to gross similarity of tumor and brain tissue • Adjacency of essential cortex (e.g. motor, language) makes distinction critical

  3. Craniotomy=699 Brain biopsy=180 LASER ablation=9 Transsphenoidal pituitary adenoma resection Total=918 Intra-operative MRI at BWH

  4. MRT allows surgeon to visualize resection progress and brain shift F. Talos

  5. Functional MRI can provide a pre-operative map of critical brain areas • Motor, visual cortex well demonstrated • Language lateralization • Increasingly, language localization and memory

  6. Lower diffusion across fiber axons Higher diffusion along fiber Imaging white matter tracts • MRI measures diffusion of water. • Water proton diffusion facilitated parallel to fibers and restricted perpendicular • anisotropic diffusion tensor imaging • Trajectory and location of white matter tracts • Three types of lesion/fiber tract interactions may occur: • fiber tract displacement • infiltration • destruction

  7. Fiber tracts Stimulation mapping to locate essential cortical areas

  8. Image coregistration and fusion

  9. Intraoperative image fusion and display: fMRI and Cortical Stimulation

  10. Conclusions and Future Directions • Multi-modality image fusion • Intra-operative functional testing annotation • Develop paradigms which work well for patients with neurologic deficits • Integrate fMRI with DTI and other imaging modalities • Improve ability to predict post-operative outcomes and avoid neurologic injury • Correlate fMRI signal with neuronal activity

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