Combined Utility of Functional MRI, Cortical Mapping, and Frameless Stereotaxy in the Resection of Lesions in Eloquent Areas of Brain in Children

作者：Simon Stapleton, Elaine T Kiriakopoulos, David J. Mikulis, James M. Drake, Harold J. Hoffman, Robin Humphreys, Paul M. Hwang, Hiroshi Otsubo, Stephanie Holowka, William J. Logan, James T. Rutka · 发表于：Pediatric Neurosurgery · 年份：2008 · DOI：10.1159/000121167 · 被引用次数：147 · 研究领域：Fetal and Pediatric Neurological Disorders、Vascular Malformations Diagnosis and Treatment、Epilepsy research and treatment

We studied 16 children with lesions in the eloquent brain to determine if the amalgamation of information from functional magnetic resonance imaging (fMRI), frameless stereotaxy, and direct cortical mapping and recording could facilitate the excision of these lesions while minimizing potential neurological deficits. The mean age of the children was 10 years. Fourteen children presented with seizures. All lesions were located in or near eloquent cerebral cortex. fMRI was successful in all patients in delineating the relationship between the lesion and regions of task-activated cortex. The ISG wand was utilized in all cases for scalp and bone flap placement, and for intraoperative localization of the lesion. Direct cortical stimulation or recording of phase reversals with somatosensory evoked potentials helped delineate the central sulcus and language cortex in patients with lesions near the motor or language cortex. Intraoperative electrocorticography (ECoG) was utilized in all patients who presented with seizures to guide the extent of resection of the epileptiform cortex. Ten children had benign cerebral neoplasms, nine of which were totally resected. The other diagnoses included vascular malformations, Sturge-Weber, tuberous sclerosis, Rasmussen's encephalitis, and primitive neuroectodermal tumor. Only 1 patient with a left Rolandic AVM developed a new neurological deficit postoperatively. Thirteen of fourteen patients who presented with seizure disorders were rendered eith...