REVIEW  CEREBRAL GLIOMA IN HIGHLY ELOQUENT AREAS: MANAGEMENT AND OUTCOME 

Journal of Neurosurgical Sciences 2019 April;63(2):127-34

DOI: 10.23736/S0390-5616.18.04597-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Preoperative surgical planning of glioma: limitations and reliability of fMRI and DTI tractography

Marco CONTI NIBALI ¹ ✉, Marco ROSSI ¹, Tommaso SCIORTINO ¹, Marco RIVA ^{1, 2}, Lorenzo G. GAY ¹, Federico PESSINA ^{1, 3}, Lorenzo BELLO ¹

¹ Unit of Neurosurgical Oncology, Department of Oncology and Hemato-Oncology, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy; ² Department of Medical Biotechnology and Translational Medicine, Humanitas Research Hospital, IRCCS, University of Milan, Milan, Italy; ³ Department of Biomedical Sciences, Humanitas University, Milan, Italy

Brain mapping techniques (intraoperative neurophysiology and neuropsychology) represent the gold standard in glioma surgery, and particularly in glioma resection. Since the introduction of MRI in the clinical practice, several advanced applications have been developed, like functional MRI (fMRI) and diffusion imaging-based tractography (DTI), which both have an application in glioma surgery. fMRI allows to identify cortical areas related to a specific function, DTI allows to reconstruct a model of the sub-cortical connectivity. This paper describes the clinical application of fMRI and DTI, enlightening sensitivity and specificity in comparison to gold standard and underlining their limitations in surgical decision making.

KEY WORDS: Glioma - Brain mapping - Magnetic resonance imaging - Diffusion tensor imaging