Yamamoto, Adam Kenji; (2020) Pre- and Intra-operative Functional Neuroimaging in Patients with Gliomas. Doctoral thesis (Ph.D), UCL (University College London).

Abstract

The goal of surgery for low grade gliomas is to maximise the tumour resection whilst avoiding damage to parts of the brain important for language and sensorimotor function. Gliomas are often slow growing and can induce functional changes so patients often have no neurological deficits. It is important to know pre-operatively if and where functional compensation has occurred in order to plan surgery. An accurate method of identifying these functional centres intra-operatively at the time of resection of the tumour is also critical. The research presented in this thesis details four neuroimaging experiments performed with fMRI to address these pre-operative (chapters 3,4) and intra-operative (chapters 5,6) requirements. In chapter 3, language fMRI was performed in three patients with right temporal lobe gliomas to show that task-specific differential changes in speech processing activation occur both within the tumour infiltrated right temporal lobe and contra-laterally within the unaffected left temporal lobe, a result consistent with functional re-organisation. In chapter 4, language fMRI was used to investigate the role of the right posterior superior temporal sulcus (RpSTS), in supporting speech processing in the healthy brain to better understand the importance of the pre-operative language fMRI data acquired in the three patients. The unique sensitivity of the RpSTS across a range of speech processing tasks is demonstrated. In chapter 5 a passive sensorimotor fMRI paradigm was performed in five patients with supratentorial gliomas, to show that somatotopic task-related BOLD activation can be reproducibly acquired under a surgical depth of general anaesthesia. In chapter 6 this same fMRI paradigm was then performed intra-operatively in 12 patients with supratentorial gliomas within a 1.5T MRI operating room. 67% of fMRI data sets were assessed to be clinically useful for radiological neurosurgical guidance, with the sevoflurane concentration identified as being the main contributory factor leading to technique failure.

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