Brain surface reformatted imaging (BSRI) in surgical planning for resections around eloquent cortex

Background: Resective surgeries around eloquent areas challenge neurosurgeons and neuroimaging professionals due to difficulties to find anatomic references during surgery. Advances in magnetic resonance (MR) may prevent such deficits and provide information for accurate surgical planning. However, most of these techniques are expensive and not feasible in most centers. Using brain surface reformatted imaging (BSRI) of 3-D MR images, we sought to obtain data for surgical planning in patients with lesions around the motor cortex. Methods: Thirteen patients with lesions around the eloquent areas and considered for resective surgery were evaluated. Patients had different ages with tumors and malformative lesions. They were scanned in a 1.5-T Siemens magnet with volumetric sequence after injection of Gadolinium. Postprocessing was done in an auxiliary console using MRI station software. We performed reformatting as described by Hattingen et al. [J Neurosurg 102:302-310, 2005] and used fixed skull and vascular structures as anatomical references. Distances to the reference points were measured to allow surgical planning and locate sites for cortical stimulation. Patients were also studied by blood-oxygen-level-dependent functional magnetic resonance imaging to locate the hand area before the surgical procedure. All patients had cortical stimulation during the resective procedure or chronic electrode stimulation before surgery. Results: There was concordance between data from functional and structural data. In one case, partial resection was performed due to the high risk of severe deficits. Even in this case, there were clinical improvements and no additional deficits were observed. Conclusions: BSRI may be a useful tool for surgical planning around eloquent areas. It can reduce surgical time and morbidity and showed correlation with functional studies. Added to this is the low cost and feasibility in most centers that have standard MR scanners with Multiplanar Reformatting software.