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Goals of Presurgical Planning

Goals of Presurgical Planning. Identify focus (epilepsy surgery) Maximize surgical resection Avoid functionally eloquent cortex and white matter tracts INDISPENABLE FOR FUNCTION IF INJURED OR REMOVED- FUNCTIONAL DEFICIT. Functionally Eloquent Cortex.

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Goals of Presurgical Planning

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  1. Goals of Presurgical Planning Identify focus (epilepsy surgery) Maximize surgical resection Avoid functionally eloquent cortex and white matter tracts INDISPENABLE FOR FUNCTION IF INJURED OR REMOVED- FUNCTIONAL DEFICIT

  2. Functionally Eloquent Cortex Essentials of Anatomy & Physiology, Seeley

  3. Functional MRI Color Overlay of Statistical Maps on Anatomical Images

  4. Readouts • Location of activation • 3D extent of activation • Distance of border of activation cluster to lesion • Laterality index of language (Lt vs Rt) • Based upon signal magnitude change

  5. QIBA fMRI Subcommittee • New Claims: • A. On a test-retest basis, fMRI can be performed reproducibly to a level such that the center of mass of activation of a focus of interest is within 5mm of itself, with at least 90% overlap of the activation clusters. • B. On a test-retest basis, fMRI can be performed reproducibly to a level such that the relative magnitude of activation in homologous regions across hemispheres should be within 10%. • C. Quantitative measures of “risk” to eloquent brain structures… distance metrics… etc.

  6. Where do we go from here? • Create a roadmap to refine claims • Assess test-retest reprod multisite by using ASFNR to develop a harmonized approach across institutions • Level stratification of claims • Ideal – may require additional info • Target - majority • Acceptable - min competency

  7. Next Steps • Mine FBIRN, ADNI, QIBA FDG-PET in conf calls • Develop phantom to calibrate T2* change and fSNR. • Assess geometric spatial accuracy with B Field mapping to correct geometric distortion • Enroll our “customers” in telecon or stand alone meeting • Extending readouts to other contexts for use such as neuropsychiatric, neurodegenerative, pharmacologic

  8. Thanks! • Dan Sullivan • Jeff Evelhoch • Madeline McCoy

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