Identification of Hand Motor Area using Functional MRI for the Epilepsy Patients with Lesions around the Motor Area ? Comparison with the MEG and Intraoperative Functional Mapping-

[Objective] We evaluated the localization of motor function using functional MRI for the epilepsy patients with lesions around the motor strip. To evaluate the efficacy of F-MRI, we compared the localization of motor area between MRI, functional MRI, direct cortical stimulation, and Magnetoencephalography. [Method] Total 16 epilepsy patients were included in this study. Motor strip detection on MRI was performed based on the Iwasaki\u27s method. F-MRI was performed using 1.5 tesler MRI, task of tapping fingers in each hand. The activated area was visualized over the MRI and compared with the results of other modalities. [Results] We divided the patients into two groups based on the identification of motor strip on MRI. Ten patients showed clear anatomical motor strip on MRI, in which nine exhibited single gyrus activation, concordant with the anatomical motor strip on MRI. Only one patient showed two gyri activation. Six patients showed unclear motor strip on MRI, in which 3 demonstrated single gyrus activation, concordant with the direct cortical stimulation results. Three patients presented two gyri activation, evolving true motor strip. Four patients underwent MEG examination, which showed concordant results with the cortical stimulation results. [Conclusions] F-MRI is useful for the preoperative motor area estimation, especially for the patients with clear central sulcus on MRI. If more than two gyri would be activated on functional MRI, further evaluations of MEG, as well as intraoperative functional mapping would be recommended to confirm the correct motor strip

Cortical Functional Mapping Under Awake Craniotomy Advantages and Problems

[Objective] We introduce our functional mapping method under awake craniotomy and evaluated the utility, effectiveness, and surgical outcomes. The advantages and problems of intraoperative awake surgery were discussed. [Method] Two patients with glioma were included in this study. Case 1 showed left temporal lesion with clear margin. Case 2 presented the left parietal diffuse lesion. Preoperative functional examinations of Wada test, functional MRI (fMRI), and MEG were performed for the preparation of awake surgery. Preoperative functional data was registered on the Neuro-navigation system. Intraoperative awake functional mapping was made under the propofol anesthesia. Avoiding of their functional area, we removed their lesions under the confirmation of stimulation method. [Results] Both patients underwent awake craniotomy surgery successfully without permanent neurological deficit. Case 1: right handed 26 year-old female. She had the episode of a sudden convulsion attack. MRI showed a large left temporal lesion. During the intraoperative awake stimulation, patient showed sensory aphasia at the posterior part of the superior temporal gyrus. Gross total removal was performed without a post-operative neurological deficit. Case 2: right handed 29 year-old male. He was transferred to our hospital due to sudden generalized seizure. MRI showed diffuse left parietal lesion. He presented partial Gerstmann\u27s syndrome and sensory aphasia. Partial resection was done under an awake craniotomy. He had transient conductive aphasia postoperatively, which was improved within a couple of days. [Conclusions] Intraoperative awake stimulation was effective for the patients who have lesions over the eloquent language areas. This method has the advantage of avoiding the new neurological deficits with the maximum removal of the lesion. The problems of this method were the limitation of the stimulation time, risk of inducing refractory seizures, and strict indications of the patients who should tolerate the stressful examination. In conclusion, intraoperative awake stimulation method is one of the choices for the patients who can understand the advantages and problems of this method

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