The Neurological Institute of the Cleveland Clinic Abu Dhabi (CCAD) has been established in 2015 as a quarternary healthcare institution to provide state-of-the art care to complex neurosurgical cases. On the other hand, cutting-edge neuroimaging research at New York University Abu Dhabi (NYUAD) offers the local medical community access to latest development in neuroimaging research to complement routine clinical care.
Case presentation
In this case report, a 32-year-old female presented with fronto-parietal low grade glioma in the left hemisphere.
Given the proximity of this tumor to motor (precentral gyrus) and language areas (supramarginal and angular gyri), structural MRI was complemented with functional MRI for motor (hands and tongue) as well as diffusion tractography.
Clinical Findings
Fig. 1A shows a FLAIR scan acquired using a MAGNETOM Skyra 3T system in CCAD with 0.4 mm isotropic resolution. Axial T2 Space scans with functional activation of tongue (Fig. 1B), and hands (Fig. 1C) are shown (white arrows).
Microsurgical navigation and fluorescence aided tumor resection surgery was performed with the patient in awake-state under continuous electrophysiological and neuropsychological neuro-monitoring. Within two weeks post-surgery, the initial decreased neurological motor function returned to approximately 90% of normal (and improving), productive language function is restored to about 50% (and improving), albeit with some remaining fluency deficits (likely due to closeness of the arcuate fasciculus to the tumor region).
Conclusion
Multi-modal MRI evaluation with structural, functional, and diffusion tractography can play an important role in planning complex brain surgeries, selecting the right patients for awake surgeries and therefore contributes to optimal post-operative outcomes. Future efforts will focus on implementing language fMRI evaluation and directly use the fiber tractography and functional activation in neuro-navigation systems.