Assessment of functional MR imaging in neurosurgical planning

BACKGROUND AND PURPOSE: Presurgical sensorimotor mapping with functional MR imaging is gaining acceptance in clinical practice; however, to our knowle dge, its therapeutic efficacy has not been assessed in a sizable group of p atients. Our goal was to identify how preoperative sensorimotor functional studies were used to guide the treatment of neuro-oncologic and epilepsy su rgery patients. METHODS: We retrospectively reviewed the medical records of 46 patients who had undergone preoperative sensorimotor functional MR imaging to document how often and in what ways the imaging studies had influenced their managem ent. Clinical management decisions were grouped into three categories: for assessing the feasibility of surgical resection, for surgical planning, and for selecting patients for invasive functional mapping procedures. RESULTS: Functional MR imaging studies successfully identified the function al central sulcus ipsilateral to the abnormality in 32 of the 46 patients, and these 32 patients are the focus of this report. In epilepsy surgery can didates, the functional MR imaging results were used to determine in part t he feasibility of a proposed surgical resection in 70% of patients, to aid in surgical planning in 43%, and to select patients for invasive surgical f unctional mapping in 52%, In tumor patients, the functional MR imaging resu lts were used to determine in part the feasibility of surgical resection in 55%, to aid in surgical planning in 22%, and to select patients for invasi ve surgical functional mapping in 78%, Overall, functional MR imaging studi es were used in one or more of the three clinical decision-making categorie s in 89% of tumor patients and 91% of epilepsy surgery patients. CONCLUSION: Preoperative functional MR imaging is useful to clinicians at t hree key stages in the preoperative clinical management paradigm of a subst antial percentage of patients who are being considered for resective tumor or epilepsy surgery.