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Intraoperative visualisation of language fascicles by diffusion tensor imaging-based tractography in glioma surgery

  • Clinical Article - Neurosurgical Techniques
  • Published:
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Abstract

Background

For gliomas, the goal of surgery is to maximise the extent of resection (EOR) while minimising the postoperative morbidity. The purpose of this study was to evaluate the benefits of a protocol developed for the surgical management of gliomas located in language areas, where tractography-integrated navigation was used in conjunction with direct electrical stimulations (DES).

Methods and materials

The authors included ten patients suffering of gliomas located in language areas. The preoperative planning for multimodal navigation was done by integrating anatomical magnetic resonance images and subcortical pathway volumes generated by diffusion tensor imaging. Six white matter fascicles implicated in language functions were reconstructed in each patient, including fibres for phonological processing (i.e. the arcuate fasciculus), fibres for lexical-semantic processing (i.e. the inferior frontooccipital fasciculus, inferior longitudinal fasciculus and uncinate fasciculus), and two premotor fasciculi involved in the preparation of speech movements (the subcallosal medialis fasciculus and cortical fibres originating from the medial and lateral premotor areas). During surgery, language fascicles were identified by direct visualisation on tractography-integrated navigation images and by observing transient language inhibition after subcortical DES. Language deficits were evaluated preoperatively and postoperatively, and compared with the EOR.

Results

Tractography was successfully performed in all patients, preoperatively demonstrating the relationships between the tumours to resect and the language fascicles to preserve from injury. With the use of the tractography-integrated navigation system and intraoperative DES, language functions were preserved in all patients. The mean volumetric resection was 93.0 ± 10.4 % of the preoperative tumour volume, with a gross total resection in 60 % of patients.

Conclusion

The intraoperative combination of tractography and DES contributed to maximum safe resection of gliomas located in language areas.

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Author information

Authors and Affiliations

  1. Neurosurgery Service, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France

    François Vassal & Christophe Nuti

  2. Neuroradiology Unit, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France

    Fabien Schneider

  3. Neurosurgery Service A, Hôpital Gabriel Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France

    Jean-Jacques Lemaire

  4. Medical Imagery Research Team-IGCNC (Image-Guided Clinical Neurosciences and Connectomics), Unité de Formation et de Recherche Médecine, Université Clermont 1, Clermont-Ferrand, France

    François Vassal, Anna Sontheimer & Jean-Jacques Lemaire

  5. Service de Neurochirurgie, Hôpital Nord, Avenue Albert Raimond, 42270, Saint-Priest en Jarez, France

    François Vassal

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  1. François Vassal
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Correspondence to François Vassal.

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Vassal, F., Schneider, F., Sontheimer, A. et al. Intraoperative visualisation of language fascicles by diffusion tensor imaging-based tractography in glioma surgery. Acta Neurochir 155, 437–448 (2013). https://doi.org/10.1007/s00701-012-1580-1

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  • DOI: https://doi.org/10.1007/s00701-012-1580-1

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