Frameless stereotactic functional neuronavigation combined with intraoperative magnetic resonance imaging as a strategy in highly eloquent located tumors causing epilepsy. Sommer, B., Grummich, P., Hamer, H., Bluemcke, I., Coras, R., Buchfelder, M., & Roessler, K. Stereotactic and functional neurosurgery, 92(1):59--67, January, 2014.
Frameless stereotactic functional neuronavigation combined with intraoperative magnetic resonance imaging as a strategy in highly eloquent located tumors causing epilepsy. [link]Paper  doi  abstract   bibtex   
BACKGROUND: Intractable epilepsy due to tumors located in highly eloquent brain regions is often considered surgically inaccessible because of a high risk of postoperative neurological deterioration. Intraoperative MRI and functional navigation contribute to overcome this problem. OBJECTIVES: To retrospectively investigate the long-term results and impact of functional neuronavigation and 1.5-tesla intraoperative MRI on patients who underwent surgery of tumors associated with epilepsy located close to or within eloquent brain areas. METHODS: Nineteen patients (9 female, 10 male, mean age 41.4 ± 13.4 years, 11 low-grade and 8 high-grade glial tumors) were evaluated preoperatively using BOLD imaging, diffusion-tensor imaging tractography and magnetoencephalography. Functional data were implemented into neuronavigation in this multimodal approach. RESULTS: In 14 of 19 patients (74%), complete resection was achieved, and in 5 patients significant tumor volume reduction was accomplished. Eight of 14 (57%) complete resections were achieved only by performing an intraoperative image update. Neurological deterioration was found permanently in 2 patients. After a mean follow-up of 43.8 ± 23.8 months, 15 patients (79%) became seizure free (Engel class Ia). CONCLUSIONS: Despite the highly eloquent location of tumors causing intractable epilepsy, our multimodal approach led to complete resection in more than two-thirds of patients with an acceptable neurological morbidity and excellent long-term seizure control.
@article{ sommer_frameless_2014,
  title = {Frameless stereotactic functional neuronavigation combined with intraoperative magnetic resonance imaging as a strategy in highly eloquent located tumors causing epilepsy.},
  volume = {92},
  url = {http://www.ncbi.nlm.nih.gov/pubmed/24356382},
  doi = {10.1159/000355216},
  abstract = {BACKGROUND: Intractable epilepsy due to tumors located in highly eloquent brain regions is often considered surgically inaccessible because of a high risk of postoperative neurological deterioration. Intraoperative MRI and functional navigation contribute to overcome this problem. OBJECTIVES: To retrospectively investigate the long-term results and impact of functional neuronavigation and 1.5-tesla intraoperative MRI on patients who underwent surgery of tumors associated with epilepsy located close to or within eloquent brain areas. METHODS: Nineteen patients (9 female, 10 male, mean age 41.4 ± 13.4 years, 11 low-grade and 8 high-grade glial tumors) were evaluated preoperatively using BOLD imaging, diffusion-tensor imaging tractography and magnetoencephalography. Functional data were implemented into neuronavigation in this multimodal approach. RESULTS: In 14 of 19 patients (74%), complete resection was achieved, and in 5 patients significant tumor volume reduction was accomplished. Eight of 14 (57%) complete resections were achieved only by performing an intraoperative image update. Neurological deterioration was found permanently in 2 patients. After a mean follow-up of 43.8 ± 23.8 months, 15 patients (79%) became seizure free (Engel class Ia). CONCLUSIONS: Despite the highly eloquent location of tumors causing intractable epilepsy, our multimodal approach led to complete resection in more than two-thirds of patients with an acceptable neurological morbidity and excellent long-term seizure control.},
  number = {1},
  journal = {Stereotactic and functional neurosurgery},
  author = {Sommer, Bjoern and Grummich, Peter and Hamer, Hajo and Bluemcke, Ingmar and Coras, Roland and Buchfelder, Michael and Roessler, Karl},
  month = {January},
  year = {2014},
  keywords = {Adult, Brain Neoplasms, Brain Neoplasms: complications, Brain Neoplasms: pathology, Brain Neoplasms: surgery, Cerebral Cortex, Cerebral Cortex: pathology, Electroencephalography, Epilepsy, Epilepsy: epidemiology, Epilepsy: etiology, Female, Follow-Up Studies, Humans, Incidence, Intraoperative Period, Magnetic Resonance Imaging, Magnetic Resonance Imaging: methods, Male, Middle Aged, Neuronavigation, Neuronavigation: methods, Neurosurgical Procedures, Neurosurgical Procedures: methods, Retrospective Studies, Treatment Outcome},
  pages = {59--67}
}

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