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European Radiology

, 19:2798 | Cite as

Pre-surgical planning and MR-tractography utility in brain tumour resection

  • A. RomanoEmail author
  • G. D’Andrea
  • G. Minniti
  • L. Mastronardi
  • L. Ferrante
  • L. M. Fantozzi
  • A. Bozzao
Neuro

Abstract

The purposes of this study were (1) to evaluate the possible identification of trajectories of fibre tracts, (2) to examine the useful of a neuronavigation system for pre-surgical planning, (3) to assess pre- and post-surgery patients’ clinical condition and (4) to evaluate the impact of this information on surgical planning and procedure. Twenty-eight right-handed patients were prospectively and consecutively studied. All the patients were clinically assessed by a neurologist in both pre- and post-surgical phases. Separately the pyramidal tract, optic radiation and arcuate fasciculus were reconstructed. The trajectories were considered suitable for surgical planning if there were no interruptions of any of the layers at the level of the lesion. Dedicated software ‘merged’ the acquired images with the tractographic processing, and the whole dataset was sent to the neuronavigation system. The assessment of the 37 visualised trajectories close to the tumour resulted in a modification of the surgical approach to corticotomy in six patients (21%); the impact on the definition of the resection margins during surgery was 64% (18 cases). The overall impact percentage on the surgical procedure was 82%. In 27 cases, the symptoms had not changed. MR-tractography provides the neurosurgeon with a new anatomical view that has an impact on the surgical resection planning for brain neoplasms.

Keywords

Pre-surgical planning Diffusion tensor imaging MR tractography Intra-operative MRI Intra-axial brain tumours 

References

  1. 1.
    Yu CS, Li KC, Xuan Y, Ji XM, Qin W (2005) Diffusion tensor tractography in patients with cerebral tumors: a helpful technique for neurosurgical planning and postoperative assessment. Eur J Rad 56:197–204CrossRefGoogle Scholar
  2. 2.
    Jellison BJ, Field AS, Medow J, Lazar M, Salamat MS, Alexander AL (2004) Diffusion tensor imaging of cerebral white matter: a pictorial review of physics, fiber tract anatomy and tumor imaging patterns. AJNR Am J Neuroradiol 25:356–369PubMedGoogle Scholar
  3. 3.
    Field AS, Alexander AL, Wu YC, Hasan KM, Witwer B, Badie B (2004) Diffusion tensor eigenvector directional colour imaging patterns in the evaluation of cerebral white matter tracts altered by tumor. J Magn Reson Imaging 20:555–562CrossRefPubMedGoogle Scholar
  4. 4.
    Sunaert S (2006) Presurgical planning for tumor resectioning. J Magn Reson Imaging 23:887–905CrossRefPubMedGoogle Scholar
  5. 5.
    Nimsky C, Ganslandt O, Merhof D, Sorensen AG, Fahlbusch R (2006) Intraoperative visualization of pyramidal tract by diffusion-tensor imaging-based fiber tracking. Neuroimage 30:1219–1229CrossRefPubMedGoogle Scholar
  6. 6.
    Nimsky C, Ganslandt O, Fahlbusch R (2006) Implementation of fiber tract navigation. Neurosurgery 58:292–304CrossRefGoogle Scholar
  7. 7.
    Stadlbauer A, Nimsky C, Buslei R, Salomonowitz E, Hammen T, Buchfelder M, Moser E, Ernst-Stecken A, Ganslandt O (2007) Diffusion tensor imaging and optimized fiber tracking in glioma patients: histopathologic evaluation of tumor-invaded white matter structures. Neuroimage 34:949–956CrossRefPubMedGoogle Scholar
  8. 8.
    Nimsky C, Ganslandt O, Von Keller B, Romstöck J, Fahlbusch R (2004) Intraoperative high-field strength MR imaging: implementation and experience in 200 patients. Radiology 233:67–78CrossRefPubMedGoogle Scholar
  9. 9.
    Hori M, Ishigame K, Shiraga N, Kumagai H, Aoki S, Araki T (2008) Mean diffusivity, fractional anisotropy maps, and three-dimensional white matter tractography by diffusion tensor imaging. Comparison between single-shot fast spin-echo and single-shot echo-planar sequences at 1.5 Tesla. Eur Radiol 18:830–834CrossRefPubMedGoogle Scholar
  10. 10.
    Basser PJ, Pajevic S, Pierpaoli C, Duda J, Aldroubi A (2000) In vivo fiber tractography using DT-MRI data. Magn Reson Med 44:625–632CrossRefPubMedGoogle Scholar
  11. 11.
    Mori S, Van Zjil PC (2002) Fiber tracking: principles and strategies - a technical review. NMR Biomed 15:468–480CrossRefPubMedGoogle Scholar
  12. 12.
    Mori S, Crain BJ, Chacko VP, van Zijl PC (1999) Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging. Ann Neurol 45:265–269CrossRefPubMedGoogle Scholar
  13. 13.
    Stieltjes B, Kaufmann WE, van Zijl PC, Fredericksen K, Pearlson GD, Solaiyappan M, Mori S (2001) Diffusion tensor imaging and axonal tracking in the human brainstem. Neuroimage 14:723–735CrossRefPubMedGoogle Scholar
  14. 14.
    Bello L, Gambini A, Castellano A, Carrabba G, Acerbi F, Fava E, Giussani C, Cadioli M, Blasi V, Casarotti A, Papagno C, Gupta AK, Gaini S, Scotti G, Falini A (2008) Motor and language DTI fiber tracking combined with intraoperative subcortical mapping for surgical removal of gliomas. Neuroimage 39:369–378CrossRefPubMedGoogle Scholar
  15. 15.
    Mori S, Kaufmann WE, Davatzikos C, Stieltjes B, Amodei L, Fredericksen K, Pearlson GD, Melhem ER, Solaiyappan M, Raymond GV, Moser HW, van Zijl PC (2002) Imaging cortical association tracts in the human brain using diffusion-tensor-based axonal tracking. Magn Reson Med 47:215–223CrossRefPubMedGoogle Scholar
  16. 16.
    Catani M, Jones DK, Fytche DH (2004) Perisylvian language networks of the human brain. Ann Neurol 57:8–16CrossRefGoogle Scholar
  17. 17.
    Wakana S, Jiang H, Nagae-Poetscher LM, van Zijl PC, Mori S (2004) Fiber tract-based atlas of human white matter anatomy. Radiology 230:77–87CrossRefPubMedGoogle Scholar
  18. 18.
    Laundre BJ, Jellison BJ, Badie B, Alexander AL, Field AS (2005) Diffusion tensor imaging of corticospinal tract before and after mass resection as correlated with clinical motor findings: preliminary data. AJNR Am J Neuroradiol 26:791–796PubMedGoogle Scholar
  19. 19.
    Kober H, Nimsky C, Möller M, Hastreiter P, Fahlbusch R, Ganslandt O (2001) Correlation of sensorimotor activation with functional magnetic resonance imaging and magneto-encephalography in presurgical functional imaging: a spatial analysis. Neuroimage 14:1214–1228CrossRefPubMedGoogle Scholar
  20. 20.
    Nimsky C, Ganslandt O, Kober H, Moller M, Ulmer S, Tomandl B, Fahlbusch R (1999) Integration of functional magnetic resonance imaging supported by magneto-encephalography in functional neuronavigation. Neurosurgery 44:1249–1256CrossRefPubMedGoogle Scholar
  21. 21.
    Nimsky C, Ganslandt O, Hastreiter P, Wang R, Benner T, Sorensen AG, Fahlbusch R (2005) Intraoperative diffusion tensor MR imaging: shifting of white matter tracts during neurosurgical procedures - initial experience. Radiology 234:218–225CrossRefPubMedGoogle Scholar
  22. 22.
    Nimsky C, Ganslandt O, Hastreiter P, Wang R, Benner T, Sorensen AG, Fahlbusch R (2004) Preoperative and intraoperative diffusion tensor imaging-based fiber tracking in glioma surgery. Neurosurgery 56:130–137Google Scholar
  23. 23.
    Kinoshita M, Yamada K, Hashimoto N, Kato A, Izumoto S, Baba T, Maruno M, Nishimura T, Yoshimine T (2005) Fiber-tracking does not accurately estimate size of fiber bundle in pathological condition: initial neurosurgical experience using neuronavigation and subcortical white matter stimulation. Neuroimage 25:424–429CrossRefPubMedGoogle Scholar
  24. 24.
    Kamada K, Todo T, Masutani Y, Aoki S, Ino K, Takano T, Kirino T, Kawahara N, Morita A (2005) Combined use of tractography-integrated functional neuronavigation and direct fiber stimulation. J Neurosurg 102:664–672CrossRefPubMedGoogle Scholar
  25. 25.
    Gambini A, Bello L, Falini A (2006) Corrispondenza tra Fiber Tracking e siti di neurostimolazione sottocorticale intraoperatoria dei circuiti motori e del linguaggio in pazienti affetti da tumori cerebrali. Neuroradiol J 19(Suppl. 1):70–71Google Scholar
  26. 26.
    Keles GE, Lundin DA, Lamborn KR, Chang EF, Ojemann G, Berger MS (2004) Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients. J Neurosurg 100:369–375CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • A. Romano
    • 1
    Email author
  • G. D’Andrea
    • 2
  • G. Minniti
    • 3
  • L. Mastronardi
    • 2
  • L. Ferrante
    • 2
  • L. M. Fantozzi
    • 1
  • A. Bozzao
    • 1
  1. 1.Department of Neuroradiology, S. Andrea HospitalUniversity SapienzaRomeItaly
  2. 2.Department of Neurosurgery, S. Andrea HospitalUniversity SapienzaRomeItaly
  3. 3.Department of Radiotherapy, S. Andrea HospitalUniversity SapienzaRomeItaly

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