Visualization of the pyramidal tract in glioma surgery by integrating diffusion tensor imaging in functional neuronavigation.

OBJECT: The aim of this study was to investigate whether diffusion tensor imaging (DTI) can be integrated into functional navigation for the intraoperative visualization of the pyramidal tract. METHODS: A single-shot spin-echo diffusion-weighted echo planar imaging sequence on a 1.5 T magnetic resonance (MR) scanner was used for DTI. One null image and six diffusion-weighted images (high B value 1 000 mm/s (2)) were obtained. Color-encoded fractional anisotropy maps of the principal eigenvector rendered as a boxoid within each voxel were used for segmentation of the pyramidal tract. The segmented images were rigidly registered with a T(1)-weighted gradient echo 3D dataset for navigation in 16 patients with gliomas. In tumors adjacent to the motor cortex (n = 6) data from functional MR imaging were co-registered. RESULTS: The whole DTI processing lasted about 25-30 minutes in each case. In all cases DTI could be integrated into the navigational dataset resulting in an intraoperative visualization of the pyramidal tract by microscope-based navigation. Navigational accuracy measured as the target registration error was 1.2 +/- 0.46 mm. Registration of fractional anisotropy maps with the 3D navigational dataset was possible with an error of less than 2 mm. Co-registration with fMRI was consistent with DTI data. A neurological deterioration was observed only in one patient. CONCLUSIONS: DTI can be reliably integrated into navigational datasets. Thus, microscope-based neuronavigation can be used for an intraoperative visualization of the course of the pyramidal tract. However, a possible shifting of the pyramidal tract has to be taken into account after major tumor parts are removed.

Magnetic source imaging supports clinical decision making in glioma patients.

OBJECTIVE: This study addresses the potential utility of preoperative functional imaging with magnetoencephalography (MEG) for the selection of glioma patients who are likely to benefit from resective surgical treatment regarding postoperative morbidity. METHODS: One hundred and nineteen patients with gliomas adjacent to sensorimotor, visual and speech related brain areas were investigated preoperatively with a MAGNES II biomagnetometer. In each patient the pre-surgical evaluation was focussed on the visual, sensorimotor cortex and/or of the speech related brain areas. A grading system was then used according to the distance of the MEG activation sources to the nearest tumour border to determine the further treatment. The therapeutic options consisted in conservative treatment, stereotactic biopsy and/or a radiation and chemotherapy, substantial cytoreduction and the gross total removal of the lesion. RESULTS: From 119 investigated patients, 55 patients (46.2%) were not considered for surgery due to tumour invasion to functional cortex. Sixty four patients (53.8%) were chosen for resective surgery. In the surgical group only four patients (6.2%) suffered from neurological deterioration. CONCLUSIONS: Magnetic source imaging (MSI) proved to be a valuable help in the clinical decision making process of lesions adjacent to functional important brain areas. The relative high number of patients in whom MSI warns of the postoperative crippling sequelae may lead to a better selection of patients who benefit from resective surgery. This method may help to find the patients for whom conservative treatment seems to be more favourable concerning quality of life in the surviving time.

Sources of spontaneous slow waves associated with brain lesions, localized by using the MEG.

Electric or magnetic slow wave brain activity can be associated with brain lesions. For an accurate source localization we transformed the magnetoencephalographic (MEG) coordinate system to the magnetic resonance imaging (MRI) system by using a surface fit of the digitally measured head surface and the reconstructed surface of the MRI scan. Furthermore we solved the problem to separate sources of focal activity from other multiple sources by introducing a spatial average, the Dipole Density Plot (DDP). The DDP shows in a quantified manner concentrations of dipoles across time. The DDP uses the single dipole model adequately, because only those signal sections will be analyzed, where one component contributes to the signal predominantly. In all cases, where multiple sources concurrently active are to be localized, a current distribution analysis will be used, the Current Localization by Spatial Filtering (CLSF). All source localization procedures were tested using structural brain lesions, which were verified by imaging techniques (MRI or CT), showing the results in close topographical relation to the lesions. The results so far let us assume, that the DDP and the CLSF are valuable tools to localize sources of focal spontaneous slow wave electrical brain activity.

Distributed current analyses of bi-hemispheric magnetic N1m responses to ipsi/contralateral monaural stimuli from a single subject.

Magnetoencephalographic (MEG) responses of both auditory cortices to simple auditory stimuli presented monaurally to either ear were recorded from a single subject. A distributed current model and a current dipole model were used to analyse the responses at the latency of the dominant N1m complex. At the N1m the current density was localised to a single area and was consequently well modelled by a single current dipole close to the peak current density. In the left hemisphere, the contralateral response (as identified by the peak current density) preceded the ipsilateral response by 3 msec. This value was 7 msec for the right hemisphere. Evidence was found in the right hemisphere of a posterior-anterior movement along the sylvian fissure. Also, the left hemisphere N1m sources were all represented more posterior than the right hemisphere N1m sources.

Estimates of brain activity using magnetic field tomography in a GO/NOGO avoidance paradigm.

This paper presents the first estimates of three dimensional evolution of activity in the brain associated with a GO/NOGO avoidance (CNV) paradigm. These estimates are continuous probabilistic solutions (Ioannides et al. 1990) to the biomagnetic inverse problem, obtained from averaged multichannel magnetoencephalographic (MEG) recordings (Vieth et al. 1991). The emphasis here is placed on the comparison of the activity associated with the GO and NOGO conditions; estimates of activity are shown for the onset of warning stimulus (S1), the early response half a second after S1, the late response lasting for over one second before S2 (the time between S1 and S2 is 3.5 seconds) and the onset of the imperative stimulus (S2). We find responses in regions of the brain implicated with hearing the stimulus, task engagement and motor output. Differences in the images corresponding to GO and NOGO conditions are significant because they reflect differences in brain function when a motor response is required or must be inhibited.

Magnetic fields of the brain analysed by a multiple dipole approach using factor analysis.

Sudden spatial changes in consecutive dipole localisations suggest that often a single-moving-dipole algorithm is inadequate. This is particularly important in the case of widespread activity in the brain, where one extremum may be extinguished by another. One example of widespread activity is the alpha rhythm. The application of factor analysis may give information about the presence of different active sources. The alpha rhythm showed two to three significant factors. This suggests that the apparent movement suggested by single-dipole localisation may be caused by the superposition of the fields of two spatially and temporally distinct sources. Field maps which are very similar to a dipole pattern may be caused by a superposition of the fields of several sources.