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Preoperative patients in need of brain surgery for varying brain pathology who require presurgical brain mapping with MRI (fMRI, and dMRI)

This prospective study aims to investigate and validate the use of resting-state functional MRI (rs-fMRI) and high angular resolution diffusion imaging (HARDI), specifically constrained spherical deconvolution (CSD) tractography, for functional and structural brain mapping prior to neurosurgery. The goal is to assess the feasibility of replacing task-based fMRI (tb-fMRI) and diffusion tensor imaging (DTI) with fiber tractography (FT) using the fiber assignment by continuous tracking (FACT) algorithm. The study focuses on mapping sensory-motor, language, visual, and higher cognitive functional and structural networks in patients with brain pathology suitable for surgical intervention. The objective is to improve neurosurgical planning, navigation, and risk assessment through the utilization of rs-fMRI and CSD tractography.

This study aims to prospectively investigate and validate the application of resting state functional MRI (rs-fMRI) and High angular resolution diffusion imaging (HARDI), particularly constrained spherical deconvolution (CSD) tractography, in presurgical functional and structural brain mapping for the purposes of neurosurgical planning, navigation and risk assessment. The main objective is to determine whether rs-fMRI and CSD tractography are capable of replacing task based fMRI (tb-fMRI) and diffusion tensor imaging (DTI) based fiber tractography (FT) using the fiber assignment by continuous tracking (FACT) algorithm for mapping the sensory-motor, language, visual, as well as higher cognitive functional and structural networks of the brain in patients with brain pathology amenable for surgical intervention. This research question will be investigated by acquiring tb-fMRI and rs-fMRI, as well as HARDI data for presurgical patients. The routine workflow of presurgical planning and risk assessment using tb-fMRI and DTI FT will be followed and used for the initial planning. Previous studies have revealed a high degree of concordance between rs-fMRI and tb-fMRI\[1\]-\[5\] as well as between CSD and DTI FT\[6\]-\[8\], but drew such conclusions from relatively small sample sizes. The aim is to incorporate the rs-fMRI and CSD results into the presurgical planning process albeit with more weight assigned to the tb-fMRI and DTI results. The study population will consist of 10 normal controls for MR imaging optimization purposes only, 150 presurgical patients from the UZ Leuven imaging department regardless of the exact type of pathology (space occupying lesions, epilepsy, vascular malformations etc.).

As tb-fMRI has previously been validated versus the gold standard of functional mapping, electrical cortical stimulation (ECS), while rs-fMRI has previously been validated against tb-fMRI. The same has been done comparing DTI and CSD. To our knowledge however, a comparative study with such a large and diverse study population attempting to cross validate all these modalities against the gold standard has not yet been done.

Image acquisition acceleration methods, such as parallel imaging (PI), simultaneous multislice acquisitions (SMS) and compressed sensing (CS) will be used whenever feasible. These acceleration methods can potentially be exploited to improve fMRI, and dMRI data quality as well as shorten acquisition time. In the case of fMRI, PI and SMS can be used to increase temporal resolution, temporal signal to noise ratio and even spatial resolution. dMRI stands to benefit from such techniques by increasing directional and/or spatial resolution.

Can we Use Resting-state fMRI and CSD Fiber Tractography for Presurgical Mapping?

The Use of Resting State fMRI and CSD Tractography for Pre-operative Brain Mapping: a Cross-sectional Study

Anonymized and coded data may be shared with other research groups upon reasonable request to the authors.

A comparative analysis examining differences in accuracy measures between different fMRI and dMRI tractography methods, namely resting-state fMRI v. task-based fMRI and DTI v CSD diffusion tractography using intraoperative direct electrical stimulation results as the ground truth

Universitaire Ziekenhuizen KU Leuven

Principal Investigator

Pharmaceutical Solutions

All Drugs and Chemicals

Plasma-lyte 148

Ophthalmic Solutions

The patients in this group will receive up to 2000 ml of normal saline during neurosurgical operation.

The patients in this group will receive up to 2000 ml of balanced fluids during neurosurgical operation.

Plasma osmolality, acid base status and electrolytes after application up to 2000 ml of normal saline during neurosurgical operation

Normal saline

Plasma osmolality, acid base status and electrolytes after application of up to 2000 ml balanced fluids during neurosurgical operation

Balanced fluid

Natasa Kovac, M.D.

Inga Mladic Batinica, M.D.

The purpose of this study was to investigate whether the balanced fluids therapy change plasma osmolality in neurosurgical procedures due to brain tumors, meningeomas and arterio-venous malformation.

Normal saline or 0.9% sodium chloride solution is the most commonly used intravenous fluid worldwide and its composition are 154 mmol Na+ and 154 mmol Cl- per litter with osmolality of 308 mOsmol/L. That composition is not "normal" because plasma contains potassium in range between 137-146 mmol/L, and chloride in range between 98-106 mmol/L, with plasma osmolality of 280-295 mOsmol/kg. Recently published data suggested detrimental effects of chloride rich fluids on renal blood flow and glomerular filtration rate, urine output and acute kidney injury. One alternative to saline solution is a buffered, balanced, crystalloid solution with an electrolyte composition similar to plasma and osmolality between 286-295 mOsmol/L. Someone could indicate that such balanced solutions are not suitable for neurosurgical patients because of a possible impact on the brain edema development.

Normal Saline Vrs Balanced i.v. Fluids in Neurosurgery

Comparison of Normal Saline and Balanced Crystalloid Intravenous Therapy During Neurosurgery

Whether the applied fluids affect plasma osmolality

Changes in acid base pH status after each 500 ml of normal saline vrs. balanced fluid

Electrolytes changes (sodium and chloride) after each 500 ml of normal saline vrs. balanced fluid

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Can we Use Resting-state fMRI and CSD Fiber Tractography for Presurgical Mapping?	NCT06040580	Brain Tumor Brain Pathology Epilepsy Vascular Malfor...		-	Universitaire Ziekenhuizen KU Leuven
Normal Saline Vrs Balanced i.v. Fluids in Neurosurgery	NCT03429127	Benign Neoplasm... Vascular Malfor...	Normal saline Balanced fluid	18 Years -	Clinical Hospital Centre Zagreb
Can we Use Resting-state fMRI and CSD Fiber Tractography for Presurgical Mapping?	NCT06040580	Brain Tumor Brain Pathology Epilepsy Vascular Malfor...		-	Universitaire Ziekenhuizen KU Leuven

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