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[Applications of functional magnetic resonance imaging in pre-surgical patients: motor, mnemonic and linguistic functions].

AIMS
This paper reviews and describes cases involving useful protocols for pre-surgical evaluation in functional magnetic resonance imaging (fMRI) of the motor, mnemonic and linguistic functions.


DEVELOPMENT
The application of fMRI in pre-surgical evaluation allows us to pinpoint the anatomical location of a function in relation to the lesion. This technique therefore appears as an alternative to the classical intraoperative tests, which are more aggressive and costly. The paper describes aspects and considerations of fMRI with regard to the methodology and procedure employed in its application, as well as the control of contaminating variables that can affect results. The language protocols are described in terms of lateralisation and localisation, and are divided into expressive and receptive language protocols, together with linguistic protocols for overall stimulation that allow the localisation of both expressive and receptive areas. Concerning the motor protocols, we describe the procedures for patients with and without difficulties in their movement. Lastly, we review and describe the memory protocols that give rise to bilateral stimulation in the mesial temporal areas, which allows both lateralisation and localisation of the hippocampal and parahippocampal areas that are functionally significant for the patients' memory. Each of the protocols is illustrated with cases carried out by our work team.


CONCLUSIONS
The development of new protocols for pre-surgical evaluation must be guided by greater delimitation and consistency in functional stimulation, as well as analysis of the behaviour displayed.