Sulci and gyri are topological cerebral landmarks in individual subjects: a study of brain navigation during tumour resection

Surgical resection of brain tumours aims at the maximal safe resection of the pathological tissue with minimal functional impairment. To achieve this objective, reliable anatomical landmarks are indispensable to navigate into the brain. The neuronavigation system can provide information to target th...

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Published inThe European journal of neuroscience Vol. 55; no. 8; pp. 2037 - 2046
Main Authors Tomaiuolo, Francesco, Raffa, Giovanni, Morelli, Adolfo, Rizzo, Vincenzo, Germanó, Antonino, Petrides, Michael
Format Journal Article
LanguageEnglish
Published France Wiley Subscription Services, Inc 01.04.2022
John Wiley and Sons Inc
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ISSN0953-816X
1460-9568
1460-9568
DOI10.1111/ejn.15668

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Summary:Surgical resection of brain tumours aims at the maximal safe resection of the pathological tissue with minimal functional impairment. To achieve this objective, reliable anatomical landmarks are indispensable to navigate into the brain. The neuronavigation system can provide information to target the location of the patient's lesion, but after the craniotomy, a brain shift and relaxation mismatch with it often occur. By contrast, sulci/gyri are topological cerebral landmarks in individual patients and do shift with the brain parenchyma during lesion removal, but remain independent from brain shift in relation to the sulci/gyri. Here, we present a case report of a novel strategy based on anatomical landmarks to guide intraoperative brain tumour resection, without using a standard neuronavigation system. A preoperative brain mapping of the peri‐tumoural sulci by the MRI and surface reconstruction was followed by confirmation of the anatomical landmarks for the motor cortex using navigated transcranial magnetic stimulation. The resulting location was used as a seed for diffusion tensor imaging tractography to reconstruct the corticospinal tracts. These selected cortical landmarks (sulci/gyri) delimited the margins of the two lesions and the specific location under which the corticospinal tract courses, thus facilitating monitoring of the peri‐tumoural region during brain resection. In this case, 96% of the brain tumour from the pericentral somatomotor region was successfully removed without chronic post‐operative motor impairments. This approach is based on cortical anatomy that is fixed during surgery and does not suffer from the brain shift that could misplace the lesion according to the neuronavigation system. Preoperative brain mapping of the peri‐tumoural sulci visualized by the MRI and the cerebral surface reconstruction for brain tumour resection. Sulci/gyri are topological cerebral landmarks in individual patients and do shift with the brain parenchyma during lesion removal, but remain independent from brain shift in relation to the tumour. Sulci and gyri can be used to localize and stimulate specific cortical areas in order to avoid behavioural functional deficits after surgery.
Bibliography:Funding information
CIHR Foundation, Grant/Award Number: FDN‐143212
Edited by: Christoph M. Michel
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Funding information CIHR Foundation, Grant/Award Number: FDN‐143212
ISSN:0953-816X
1460-9568
1460-9568
DOI:10.1111/ejn.15668