3-DIMENSIONAL IMAGING OF CORTICAL STRUCTURE, FUNCTION AND GLIOMA FOR TUMOR RESECTION

A three-dimensional brain imaging protocol with PET and MRI was used t o visualize the cortical structure in relation to brain function and g lioma infiltration to determine tumor resectability. Methods: Sixteen patients with glioma had a PET scan with C-11-methionine to visualize tumor infiltration. The PET images were cc-registered to the patients' own MRI reconstructed to the three-dimensional brain surface images t o indicate the gyral structure and the extent of tumor infiltration. T hirteen patients, who bore tumors adjacent to the language or motor co rtex, had (H2O)-O-15 activation study to locate the eloquent cortex. T he area of tumor infiltration was superimposed on the brain surface im ages together with the language and/or motor cortex, Results: When a t umor was located within a single gyrus without influencing surface cor tical gyrus pattern, the motor and language areas were identified morp hologically by three-dimensional surface image alone. However, when th e tumor caused swelling and deformation of cortical structure, functio nal mapping with (H2O)-O-15 activation technique was essential in loca ting them correctly. In such cases, the combined mapping of the facial motor area with oral movement and the language area with word repetit ion was the most useful method to identify the parasylvian structure i n the dominant hemisphere. Total or near total resection of low-grade glioma in eight patients and the effective decompression of the active part of the malignant glioma in four patients was completed without c ausing functional neurological deterioration. Conclusion: The three-di mensional expression of cortical structure and function combined with PET glioma imaging with C-11-methionine is useful for radical resectio n of cerebral glioma.