Combination of functional magnetic resonance imaging-guided neuronavigation and intraoperative cortical brain mapping improves targeting of motor cortex stimulation in neuropathic pain.

Details

Serval ID
serval:BIB_03C32B67A1A2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Combination of functional magnetic resonance imaging-guided neuronavigation and intraoperative cortical brain mapping improves targeting of motor cortex stimulation in neuropathic pain.
Journal
Neurosurgery
Author(s)
Pirotte B., Voordecker P., Neugroschl C., Baleriaux D., Wikler D., Metens T., Denolin V., Joffroy A., Massager N., Brotchi J., Levivier M.
ISSN
1524-4040 (Electronic)
ISSN-L
0148-396X
Publication state
Published
Issued date
2005
Peer-reviewed
Oui
Volume
56
Number
2 Suppl.
Pages
344-359
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
OBJECTIVE: To evaluate, regardless of the clinical results, the contribution of combining functional magnetic resonance imaging (fMRI) with intraoperative cortical brain mapping (iCM) as functional targeting methods for epidural chronic motor cortex stimulation (MCS) in refractory neuropathic pain.
METHODS: Eighteen neuropathic pain patients (central stroke in six; trigeminal neuropathy in six; syrinx or amputation in six) who underwent operations for epidural MCS were studied with preoperative fMRI and iCM. fMRI investigated motor tasks of hands (as well as foot and tongue, when painful). fMRI data were analyzed with Statistical Parametric Mapping99 software (University College London, London, England; initial analysis threshold corresponding to P < 0.001), registered in a neuronavigation system, and correlated during surgery with iCM. The primary aim of this study was to improve the topographical precision of MCS. Matching of fMRI and iCM specifically was examined.
RESULTS: Correspondence between the contour of the fMRI activation area and iCM in precentral gyrus (mean distance, 3.8 mm) was found in 17 (94%) of 18 patients. Eleven of them showed correspondence for more restrictive values of the analysis threshold (P < 0.0001); in six patients, the quality of the iCM was reduced by somatosensory wave attenuation and general anesthesia. In this group of six patients, a combination of both techniques was used for the final targeting. Correspondence was not found in one patient as the result of image distortion and residual motion artifact. At follow-up (4-60 mo), MCS induced significant pain relief in a total of 11 patients (61%).
CONCLUSION: This study confirms the functional accuracy of fMRI guidance in neuropathic pain and illustrates the usefulness of combining fMRI guidance with iCM to improve the functional targeting in MCS. Because appropriate targeting is crucial to obtaining pain relief, this combination may increase the analgesic efficacy of MCS.
Keywords
Adult, Aged, Brain Mapping, Electric Stimulation Therapy/adverse effects, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Monitoring, Intraoperative, Motor Cortex/physiopathology, Neuralgia/physiopathology, Neuralgia/therapy, Neuronavigation, Palliative Care, Retrospective Studies, Treatment Outcome
Pubmed
Create date
20/01/2008 17:36
Last modification date
20/08/2019 12:25
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