![]() To date, pre-surgical fMRI studies have had a fairly gross spatial resolution. There are multiple factors contributing to the difficulty of making pre-operative fMRI a reliable, valid and useful method for the determination of eloquent cortex. While there has been some fairly gross validation of basic motor and language function, there has not yet been any fine quantitative comparison between these methods in humans. Additionally, in order for fMRI and other non-invasive brain mapping techniques to be useful for clinical neurosurgical planning, they must be validated against the gold-standard of intraoperative ECS. In general, while basic cognitive scientists have used fMRI to investigate the brain-basis of specific cognitive processes, there has been little direct validation of these findings with electro-cortical recording from the brain. (left) Intra-operative imaging demonstrates coregistration of preoperative fMRI motor mapping data (red) with updated MR image of brain and probe position (right) Intra-operative photograph showing electrical cortical stimulation mapping with markers indicating areas which have been tested. Intraoperative use at BWH of fMRI and ECS brain mapping for localization of eloquent cortex. fMRI is non-invasive, does not require exposure to ionizing radiation, and can be readily repeated to follow clinical changes. fMRI at high field strengths has an excellent signal-to-noise ratio (SNR) and high spatial resolution and is able to demonstrate task-associated brain activity in single subjects. Since its early development, there has been tremendous enthusiasm for the potential of fMRI as a clinical tool, especially for functional mapping for brain surgery. accurately assess the validity of this approach.improve outcomes for patients with tumors in and around motor and language cortices and.develop methods which will improve fidelity of preoperative functional brain mapping.understand the relationship between the fMRI signal and neuronal activity.This translational research project combines preoperative high-resolution functional MRI (fMRI) with intraoperative electrophysiologic testing (ECS) in patients with low grade brain tumors in eloquent motor and language cortex in order to accomplish the following general goals: Pushed forward by these multidisciplinary innovations, neurosurgery has never been a safer, more effective treatment for patients with brain metastases.A Collaboration with: William “Sandy” Wells, and Eric Halgren Endoscopes, exoscopes, and fluorescent-guided surgery enable increasingly high-definition visualizations of metastatic lesions that were previously difficult to achieve. Neuronavigation has become a cornerstone of operative workflow, while intraoperative ultrasound (iUS) and intraoperative brain mapping generate real-time renderings of the brain unaffected by brain shift. Brachytherapy has highlighted the potential of locally delivering therapeutic agents to the resection cavity with high rates of local control. Supramarginal surgery has pushed the boundaries of achieving complete removal of metastases without recurrence, especially in eloquent regions when paired with intraoperative neuromonitoring. Minimally invasive neurosurgical approaches, including keyhole craniotomies and tubular retractors, optimize the preservation of normal parenchyma without compromising extent of resection. From standard magnetic resonance imaging (MRI) sequences to functional neuroimaging, preoperative workups for metastatic disease allow high-resolution detection of lesions and at-risk structures, facilitating safe and effective surgical planning. ![]() As the epidemiological and clinical burden of brain metastases continues to grow, advances in neurosurgical care are imperative.
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