Multimodal magnetic resonance imaging combined with electrical cortical stimulation under awake craniotomy for gliomas involving the language area

Objective To investigate the clinical value of functional magnetic resonance imaging(fMRI) and fiber reconstruction, combined with ultrasound and electrical cortical stimulation(ECS) technology in localizing the language area and the protection of the language function. Methods The clinical data of 28 patients with gliomas in the vicinity of the language areas who underwent multimodal MRI at the Neurosurgery Department of Affiliated Provincial Hospital of Anhui Medical University from December 2013 to October 2015 were retrospectively analyzed. There were 11 males, and 17 females. The age was 21-66 years. Blood-oxygen-level-dependent fMRI(Bold-fMRI) was used to activate language cortex pre-operatively, while diffusion tensor imaging(DTI) based fiber tracking technology was used to delineate the arcuate fasciculus. After that a 3D fusion model was generated by workstation. The positive area was localized by ECS under wake-up anesthesia, then it was marked and preserved. The extent of lesion excision was determined by intra-operative ultrasound. Postoperative review of MRI was used to evaluate the extent of lesion resection and to observe the language function of patients. Results Among 28 patients with neurogliocytoma involving the language areas, the functional area was successfully located in 25 patients. Compared with pre-operative results of fMRI, overlapping in 19 patients(73.1%) and neighborhood in 6(23.1%). Besides, the area was not found in 1 patient, 2 patients didn't cooperate properly after awakening. Post-operation scanning with DTI revealed that the shapes of arcuate fasciculus were kept in good condition.4 patients were improved in 6 patients with speech disorders. All patients were followed up for a period of 1-12 months. language function of 27 patients was well preserved. Conclusions As an effective method of noninvasive registration, multimodal MRI can be combined with real-time ultrasound and ECS to excise tumor as much as possible without wrecking function. In this way it can improve the patients' quality of life and reduce the risk of complication, and it has good application value. Key words: Neuronavigation; Glioma; Magnetic resonance imaging; Diffusion tensor imaging; Language function area; Ultrasonography; Electric stimulation