PMC4766807_01
Preoperative anatomic magnetic resonance imaging. (a) Sagittal T1-weighted contrasted magnetic resonance imaging demonstrating a rim enhancing peri-sylvian mass consistent with primary glial neoplasm. (b) Axial fluid attenuated inversion recovery magnetic resonance imaging sequence demonstrating the same peri-sylvian mass with significant surrounding edema
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F1
MRI identified a left posterior frontotemporal tumor suggestive of a high-grade glioma [Figure 1].
Preoperative resting state functional connectivity T1-weighted magnetic resonance imaging in the (a) axial, (b) sagittal and (c) coronal planes demonstrating language activations in red related to the patient's peri-sylvian mass
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F2
The patient's preoperative resting state functional connectivity MRI suggested that there was a corridor through the parietal lobe that would allow for surgical resection without damage to adjacent eloquent cortex [Figures 2 and 3].
Preoperative resting state functional connectivity T1-weighted magnetic resonance imaging in the (a) axial, (b) sagittal and (c) coronal planes demonstrating motor activations in blue related to the patient's peri-sylvian mass
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F3
The patient's preoperative resting state functional connectivity MRI suggested that there was a corridor through the parietal lobe that would allow for surgical resection without damage to adjacent eloquent cortex [Figures 2 and 3].
Intraoperative navigation system (StealthSystem, Medtronics, Inc., Minneapolis, MN, USA) demonstrating integrated resting state functional connectivity magnetic resonance imaging with preoperative anatomic T1-weighted sequence images
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F4
Following surgical exposure, stereotactic navigation was again used to confirm the optimal gyrus from which to access the tumor [Figure 4].
Postoperative anatomic magnetic resonance imaging demonstrating a small amount of residual enhancement within the anterior resection cavity, abutting motor activation as identified on preoperative resting state functional connectivity magnetic resonance imaging
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F5
Following the merger of this intraoperatively obtained imaging, it was recognized that this represented the portion of the tumor immediately abutting language cortex as identified on preoperative functional imaging [Figure 5].