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الصفحة 1
الصفحة 1
Clinical Functional MRI : Presurgical Functional Neuroimaging
Functional magnetic resonance imaging (fMRI) has contributed significantly to progress in neuroscience by permitting noninvasive imaging of the "human brain at work" under physiological conditions. Within clinical neuroimaging, fMRI is opening up a new diagnostic field by measuring and visualizing brain function. However, fMRI is not yet a standard diagnostic imaging procedure. This textbook is devoted to preoperative fMRI in patients with brain tumors and epilepsies, which are the most well-established clinical applications. By localizing and lateralizing specific brain functions in individual patients, as well as epileptogenic zones, fMRI facilitates the selection of a safe treatment and the planning and performance of function-preserving neurosurgery.
Brain tumor pathology : Current diagnostic hotspots and pitfalls
Since Bailey and Cushing (1926), all brain tumor classifications have been called histogenetic. The nosographic position that the tumor types progressively acquired in the classification systems derived from the resemblance of tumor cells to those of the cytogenesis, modified whenever new information became available from different biological research fields and especially from molecular genetics. Classically, on the basis of the rough correspondence between the mature/immature aspect of tumor cells and the benign/malignant biological behavior of the tumors, the histological labels contained a prognostic significance. The supposed origin of the tumors was thus a factor for prognosis. Later on, with the concept of anaplasia (Cox, 1933; Kernohan et al., 1949) new criteria were introduced for establishing the malignancy grades of tumors. Immunohistochemistry and later molecular genetics further refined the prognostic diagnoses, substantially increasing the opportunities to recognize the cell origin of tumors, beside revealing the pathogenetic mechanisms. Prognoses became more accurate, as required by the greater and more targeted possibilities of therapy.
Brain Metastases
Brain metastases are the most dreaded complication of systemic cancer, affecting approximately 170,000 people a year, a far greater incidence than primary brain tumors. Advances in modern chemotherapy have led to an improved control of system cancers, often with agents that poorly penetrate the central nervous system, resulting in an increasing incidence of brain metastases. Traditional chemotherapy has had little impact on brain metastases. The main therapeutic option is radiation therapy, and in a small number of patients - surgery. However, refinements in all of these treatments offer some positive outcomes and an increased ability to stratify patients based on certain criteria.
