Personal Surgery: functional brain mapping and image guided neurosurgery

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Personal Surgeryfunctional brain mapping and
image guided neurosurgery

• Alexandra J. Golby, M.D.
• Associate Surgeon
• Department of Neurosurgery
• Brigham and Womens Hospital
• Assistant Professor Harvard Medical School

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Scultetus (1653)
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Case Presentation

• Recurrent meningioma in posterior parietal
  region
• Adjacent to motor and visual areas
• Functional Brain mapping
• Define patients individual anatomy
• Inform surgical decision making

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Functional divisions of the brain
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Patients fMRI motor mapping
Hand clenching
Toe wiggling
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fMRI Setup
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Intra-operative visualization and functional
mapping
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Cortical Mapping Annotation

• Track location of stimulation and recording
  points
• Represent gyral anatomy

a Brain Tag/Event Tree b Time Stamp RAS c
Stimulation settings d Sensory/ motor/language
Events
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Diffusion tensor imaging

• Water proton diffusion is facilitated parallel to
  fibers and restricted perpendicular
• Trajectory and location of white matter tracts
  can be detected by means of anisotropic diffusion
  tensor imaging

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Intraoperative visualization of white matter
anatomy
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Automatic Segmentation of Meningioma
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Use 3D Slicer to Magnify Tumor Region
Image shows 2nd MR scan of patient while the
tumor of first scan is shown in red
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Follow Tumor Growth in 3D
Tumor in 1st Scan and 2nd Scan
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Surgical Planning and Intra-operative Decision
Making
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MRI-Guided thermal tissue ablation
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Functional brain mapping Conclusions and future
directions

• fMRI and DTI can provide neurosurgeons with
  valuable pre-operative information
• Combining multi-modality approach to maximize
  information
• Pre-operative planning and intra-operative
  decision making
• Predict post-operative outcomes and avoid
  neurologic injury