Objective: To explore the effect of stereotactic resection of small intracerebral lesions located in the motor cortex using blood oxygen level depended functional magnetic resonance imaging (BOLD-fMRI) and diffusion tensor imaging (DTI) fusion guidance.
Methods: Fifteen patients with lesions in posterior frontal lobe to anterior central gyrus, 1.5-3 cm in diameter, underwent combined three-dimensional (3D) enhancement MRI with BOLD-fMRI, and DTI. Computer procedure was used to perform the images fusion to show directly the lesions, motor cortex, and corticospinal tract, and to confirm their position relationship and design the operative approach so as to guide the stereotactic resection of the small intracerebral lesions.
Results: The images fusion demonstrated that the motor cortex and corticospinal tract were located in the lateral-posterior side of the lesions, and were both compressed, reformatted and displaced. Total removal of the lesions under microscope was achieved in 12 cases, and subtotal removal in 3 cases. Histological examination showed 3 cases of meningeoma, 3 cases of astrocytoma of grade II, 2 cases of astrocytoma of grade III, 2 cases of abscess, and 2 cases of cavernous angioma. No complication was found postoperatively.
Conclusion: Mutual complementarity can be achieved by combining 3D-enhancement MRI, BOLD-fMRI, and DTI. Stereotactic resection of the small intracerebral lesions is safe, accurate and effective under the images fusion guidance.