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Vol. 31. Issue 4.
Pages 158-164 (July - August 2020)
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Vol. 31. Issue 4.
Pages 158-164 (July - August 2020)
Clinical Research
Preoperative evaluation by functional magnetic resonance imaging in patients with dysembryoplastic neuroepithelial tumours: A case series
Evaluación prequirúrgica mediante resonancia magnética funcional en pacientes con tumores neuroepiteliales disembrioplásicos: una serie de casos
Natalia García-Casaresa,b,c,
Corresponding author
, Francisco Alfaro-Rubiob, José Ramón Ramos-Rodríguezb, Álvaro Ocaña-Ledesmaa, Bernarda Márquez-Márquezc,d, Victoria E. Fernández-Sánchezc,e, Guillermo Ibáñez-Botellac,d, Miguel Ángel Arráez-Sánchezc,d, Pedro J. Serrano-Castroc,e
a Departamento de Medicina, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
b Centro de Investigaciones Médico-Sanitarias (C.I.M.ES), Universidad de Málaga, Málaga, Spain
c Instituto de Investigación Biomédica de Málaga (I.B.I.M.A), Málaga, Spain
d Departamento de Neurocirugía, Hospital Regional de Málaga, Málaga, Spain
e Departamento de Neurología, Hospital Regional de Málaga, Málaga, Spain
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Table 1. Patient characteristics, tumour location and treatment.
Table 2. Paradigms administered and activation of brain areas.
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Abstract
Introduction

Dysembryoplastic neuroepithelial tumours (DNET) are a type of benign glioneuronal neoplasia of typically temporal location that produce drug-resistant epileptic seizures in children and young adults.

Aims

This work aims to assess the usefulness of functional magnetic resonance imaging (fMRI) in the preoperative study in four patients with DNET. A Philips Intera 3.0 Tesla magnetic resonance imaging scanner and the Blood-Oxygen-Level-Dependent (BOLD) technique were used to obtain the images, making it possible to locate the eloquent areas for language and motor areas through the application of specific paradigms.

Results

In one case the tumour was adjacent to Broca’s area, in two cases it coincided with Wernicke’s area, in one patient it was <1 cm from the motor area for the hand and in another close to memory. Only two of the patients were operated on, without postoperative functional deficit. Hemispheric activation contralateral to the tumour suggestive of neuroplasticity was observed in one of the patients.

Conclusions

fMRI is a non-invasive method that allows us to assess the proximity of lesions to eloquent areas, which is key in the evaluation of surgical risk. In addition, it allowed the detection of probable neuroplasticity in one case, which guaranteed the success of the surgery

Keywords:
Dysembryoplastic neuroepithelial tumour
Epilepsy
Functional magnetic resonance imaging
Eloquent areas
Resumen
Introducción

Los tumores neuroepiteliales disembrioplásicos (DNET) son un tipo de neoplasia glioneuronal benigna de localización típicamente temporal que producen crisis epilépticas resistentes a tratamiento farmacológico en niños y adultos jóvenes.

Objetivo

Se muestran cuatro casos valorando la utilidad de la resonancia magnética funcional (RMf) en el estudio prequirúrgico de pacientes con DNET. Para la obtención de imágenes se utilizó un equipo de resonancia magnética Philipps Intera de 3.0 Tesla y la técnica Blood Oxygenation Level-Dependent (BOLD), permitiendo localizar las áreas elocuentes de lenguaje y motora mediante la aplicación de paradigmas específicos.

Resultados

En un caso el tumor se encontraba adyacente al área de Broca, en dos casos coincidía con Wernicke, en un paciente estaba a <1 cm del área motora de la mano y en otro próximo a la memoria. Sólo dos de los pacientes fueron operados, no produciéndose déficit funcional postoperatorio. Se observó activación hemisférica contralateral al tumor sugestivo de neuroplasticidad en uno de los pacientes.

Conclusiones

La RMf supone un método no invasivo que permite evaluar la proximidad de las lesiones a las áreas elocuentes, clave en la evaluación del riesgo quirúrgico. Además, ha permitido detectar probable neuroplasticidad en un caso, la cual ha garantizado el éxito de la cirugía.

Palabras clave:
Tumor neuroepitelial disembrioplásico
Epilepsia
Resonancia magnética funcional
Áreas elocuentes

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