Predicting functional outcomes after brain surgery using MRI
Research type
Research Study
Full title
Predicting functional outcomes after brain surgery using MRI
IRAS ID
140775
Contact name
Natalie Voets
Contact email
Sponsor organisation
University of Oxford
Duration of Study in the UK
3 years, 11 months, 30 days
Research summary
Research Summary
Each year, thousands of planned neurosurgical procedures are performed for the treatment of epilepsy, tumours and vascular abnormalities. When surgical lesions are located within or close to brain tissue with known functional roles, planning safe surgical routes and deciding which patients can be offered surgery become major challenges. The ability to measure the contribution of specific brain areas to behavioural performance is, therefore, fundamentally important in assessing risks to individual patients undergoing brain surgery.
Recent evidence suggests that complex brain functions such as memory and attention rely on coordination between multiple brain regions. However, the specific brain regions involved and how they interact to support high-level brain functions is poorly understood.
Our aim is to predict the likely nature, severity and duration of deficits in patients with brain lesions affecting specific frontal or temporal lobe memory systems using cutting-edge, safe and non-invasive research brain imaging techniques to locate functionally relevant connections and active brain tissue surrounding surgical brain lesions. It is hoped that the results of this study will help plan safer neurosurgery in the future.
The study will involve 2 or 3 visits for MRI imaging investigations before and after neurosurgery at the John Radcliffe Hospital in Oxford. Funding is provided by a charitable donation and internal funds.
Summary of Results
This study, called “Predicting functional outcomes after brain surgery using MRI”, was performed at the University of Oxford. The study took place between the 16th of December 2013 and the 31st of December 2019 at the centre for Functional MRI of the Brain.
This research study was designed following our previous research in brain tumour patients. Patients routinely raise concerns before surgery about the risks of possible quality of life-related side effects of brain surgery, particularly for aspects of speech and memory. Identifying ways to accurately predict if, and how much, a given patient is at risk of such problems is crucially important for both patients and their treating surgeons. This study was designed to address these questions raised by our previous patients and their families.
Each year, thousands of planned (i.e. non-emergency) brain surgeries are performed at the John Radcliffe Hospital in Oxford. Reasons for a planned brain surgery include, for example, to treat a brain tumour. Our brain controls how we think, feel, speak, and perform all our daily activities. Brain tumour surgery therefore carries important risks to quality of life. Deciding which patients can be offered surgery is a major challenge. Advanced research MRI brain scans can offer a window onto how the brain works. One technique, called functional MRI, can measure brain activity, for example when a person tries to name or remember a picture. Another technique, called diffusion MRI, can measure important nerve connections in the brain. These techniques can offer personalised brain maps to help guide surgical decision-making. However, we don’t fully know how well these techniques can predict specific risks to individual patients undergoing brain surgery.
The main aim of the study was to find signals in functional and diffusion MRI scans that predict changes in performance after brain surgery. A second aim was to see how these signals change over time and test if those changes explain post-operative recovery.
To help us answer our research questions, 60 adults with a suspected brain tumour and 22 healthy volunteers had research MRI scans. Participants with a brain tumour had either one or two scans before surgery, and another scan after surgery. Healthy volunteers also had two scans, with a similar time interval between scans as patients.
Overall, the results of this study have helped us to better understand how brain tumours affect the way the brain processes information such as memory and language. Based on the pre-operative scans, we developed a way to measure if a tumour caused the brain networks important for language to reorganise (i.e. adapt to the tumour). By comparing the pre-operative and post-operative scans, we were able to track how surgery further affected these brain networks. The techniques used and developed in this study offer promising ways to predict the impact of brain tumour surgery on the quality of life of individual patients. This information is helping us to improve surgical planning for future brain tumour patients, leading to better and safer surgeries.
REC name
South Central - Oxford B Research Ethics Committee
REC reference
13/SC/0553
Date of REC Opinion
25 Nov 2013
REC opinion
Favourable Opinion