MSc projects 0910 001

Background: Surgery for brain tumors aims to maximise the resection margin to improve the outcome, while maintaining essential function, and can be guided by invaluable preoperative information provided by functional magnetic resonance fMRI mapping of eloquent brain areas adjacent to the tumor. We reviewed the available literature to find if the data published so far can validate the use of fMRI as a replacement to cortical electric stimulation CES.

Methods: We reviewed 53 published articles on fMRI use in brain tumor surgery for the validation of fMRI activation concordance with CES mapping, the impact of fMRI use in surgery, and the outcome associated with its use. The studies were mostly a case series reporting a small cohort of patients, without adressing the limitations of daily clinical practice like fMRI failure.

Results: Most of the studies report good concordance of fMRI with intraoperative mapping for motor and sensory areas with lower sensitivity and occasional contradictory results of mapping concordance for language function. The studies report encouraging findings of association with a better outcome, smaller craniotomy size and shorter surgery time. However, some papers raised concerns on occasional unpredictable reduced activation around high grade tumors

Conclusions: The published literatures shows encouraging results on sesetivity specialy for motor and sensory areas mapping, however in view of the methodological concerns on the published studies and the occasional false negative activation reported in some papers, there available evidence in not enough to support replacing intraoperative mapping