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Clinical application of functional magnetic resonance imaging in presurgical identification of the central sulcus

Jesús Pujol Magnetic Resonance Center of Pedralbes, Barcelona, Spain; and Department of Neurosurgery, Hospital of Bellvitge, University of Barcelona, Barcelona, Spain

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 M.D.
,
Gerardo Conesa Magnetic Resonance Center of Pedralbes, Barcelona, Spain; and Department of Neurosurgery, Hospital of Bellvitge, University of Barcelona, Barcelona, Spain

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 M.D.
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Joan Deus Magnetic Resonance Center of Pedralbes, Barcelona, Spain; and Department of Neurosurgery, Hospital of Bellvitge, University of Barcelona, Barcelona, Spain

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 Ph.D.
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Luis López-Obarrio Magnetic Resonance Center of Pedralbes, Barcelona, Spain; and Department of Neurosurgery, Hospital of Bellvitge, University of Barcelona, Barcelona, Spain

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 M.D.
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Fabián Isamat Magnetic Resonance Center of Pedralbes, Barcelona, Spain; and Department of Neurosurgery, Hospital of Bellvitge, University of Barcelona, Barcelona, Spain

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 M.D.
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Antoni Capdevila Magnetic Resonance Center of Pedralbes, Barcelona, Spain; and Department of Neurosurgery, Hospital of Bellvitge, University of Barcelona, Barcelona, Spain

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 M.D.
Page Range:
863–869
Volume/Issue:
Volume 88: Issue 5
DOI link:
https://doi.org/10.3171/jns.1998.88.5.0863
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Object. The authors sought to evaluate the advantages and limitations of functional magnetic resonance (fMR) imaging when it was used regularly in the clinical context to identify the central sulcus.

Methods. A 1.5-tesla MR system comprising a spoiled gradient recalled acquisition in the steady-state functional sequence and a cross-hand cancellation analysis method were used to evaluate 50 surgical candidates with centrally located space-occupying lesions in the brain. Three-dimensional (3-D) models of the patient's head and brain showing the relative position of the tumor and the eloquent cortex were obtained in each case. A selective and reproducible focal activation was found, indicating the probable central sulcus position in 41 patients (82%). Direct cortical stimulation confirmed the fMR findings in 100% of 22 intraoperatively assessed patients. Failure to identify the central sulcus occurred in 18% of cases and was mainly a consequence of intrinsic damage in the primary sensorimotor region that resulted in severe hand paresis.

Conclusions. Although specific factors were identified that contributed to reduced sensitivity of fMR imaging in the clinical context, the present study supports functional assessment and 3-D representation of specific surgical situations as generally feasible in common practice.

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Contributor Notes

Address reprint requests to: Jesús Pujol, M.D., Magnetic Res-
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