Presurgical fMRI evaluation of cerebral reorganization and motor deficit in patients with tumors and vascular malformations
Introduction
The risk associated with surgical treatment of cerebral tumors and vascular malformations (VMs) is particularly important when lesions are located near areas involved in functions, such as speech or motor control. In these cases, the pre-surgical planning is an essential step in order to evaluate the proximity of functional cortices to the lesion before surgery, mainly in patients without any or with very little neurological deficit. Functional imaging has become a method of choice for pre-surgical evaluation of patients with cerebral tumors or other lesions [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. Another important aspect is the evaluation of the functional reorganization in the presence of lesions [15], [16], [17], [18], [19], [20], [21], [22]. The information about the cerebral reorganization in the damaged brain could be an important decisional factor for surgical treatment. Cerebral reorganization (plasticity) is defined as the capacity of remaining areas to assume functions that are normally assumed by the damaged brain. Alkadhi et al. [15] have suggested three different patterns of cerebral organization in patients presenting with VMs situated in motor areas: functional displacement within the contralateral primary motor area (M1) (intra-hemispheric reorganization), activation of the ipsilateral M1 (inter-hemispheric reorganization) and function taken over by non-primary motor areas. In the present fMRI study, the patients presented with lesions either in the rolandic (primary motor area) or in the extra-rolandic (medial or lateral premotor cortex and superior parietal lobule) regions. In all of the patients, surgical treatment was envisaged. We wanted to know whether these patients presented with or without a cerebral reorganization before surgery and if yes, whether it depended on factors such as the type of lesion (tumor or vascular malformation) or the location within the motor cortex (primary or non-primary motor cortex). We were also interested in obtaining information about the different types of reorganization (intra-hemispheric, inter-hemispheric or function taken over by the non-primary motor areas). Another aim was to predict the possible motor deficit after surgery.
Section snippets
Patients
Seventeen patients were examined (nine male and eight female), either presenting a very weak motor deficit or without any motor deficit. The motor deficit was established qualitatively, on the basis of a clinical neurological examination. In all patients, surgical treatment for removing the lesion was considered. Five patients presented VMs (in one patient the lesion was inside the non-primary motor region and in four patients, the lesion affected the primary motor area) and 12 patients
Results
Table 1 summarizes the information about each patient: motor task, activated regions, cerebral reorganization, surgery and post-surgical outcome. Overall, regions identified as activated were those classically involved during the execution of a motor task [24].
Discussion and conclusion
FMRI was used in order to identify the motor reorganization in patients with a tumor or VM situated in motor regions and to evaluate the risk of motor deficit following surgery.
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