Clinical utility of multimodal imaging in surgical tumour patients
Research type
Research Study
Full title
Clinical utility of multimodal imaging in surgical tumour patients
IRAS ID
212712
Contact name
Francesco Vergani
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
0 years, 10 months, 17 days
Research summary
Background: The risk of inducing motor disability in neurosurgical patients with brain tumour is very high. This risk limits the possibility of radical resection and increases the frequency and rapidity of tumour recurrence. Recently, the use of intraoperative Direct Electrical Stimulation (DES) has reduced the risk of motor disability. Nevertheless DES is applied only to prevent severe motor deficits resulting from damage to the corticospinal tract. Other motor disabilities related to impaired sensory- motor integration and motor planning (e.g. apraxia) remain high.
Aims: The aim of the study is i) to develop a multimodal imaging approach for the mapping of the motor system in tumour patients undergoing neurosurgery; ii) to assess feasibility and generate preliminary data on the clinical utility of the proposed multimodal approach.
Design: Ten adult patients selected for surgery and with a tumour involving the central lobe will be recruited in this prospective longitudinal study.
Multimodal Imaging protocol: fMRI, navigated Trans Magnetic Stimulation (nTMS) and diffusion imaging tractography (DIT), will be obtained two weeks before and 3-6 months after surgery. fMRI and nTMS will be used to map the motor homunculus. Tractography maps of the principal association, commissural and projections motor tracts will be reconstructed using the fMRI activations and nTMS stimulation sites as regions of interest.Intraoperative mapping: Pre-operative volumetric MRI, along with nTMS maps and tractography will be co-registered with a frameless stereotactic neuronavigation system (S7, Medtronic Stealth, USA). Cortical and subcortical mapping to detect motor function will be performed with DES, applied with a monopolar electrode (Inomed Medizintechnik GmbH, Germany) and increasing current amplitude, starting from 1mA. Tumour resection is performed according to the functional boundaries identified intraoperatively.
Behavioural test: motor function of patients operated will be objectively tested before (two weeks) and again 3-6 months after surgery. A motor test battery developed in a previous BRC- founded study will be administered. This consists of the Grooved Pegboard (Lafayette Instruments), a co- ordinated sequential (1-2-3-2-1-2-3) multiple finger tapping test, and handwriting samples. The Goldenberg protocol for apraxia will also be collected.
REC name
Yorkshire & The Humber - South Yorkshire Research Ethics Committee
REC reference
16/YH/0383
Date of REC Opinion
15 Sep 2016
REC opinion
Further Information Favourable Opinion