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Diffusion tensor imaging fiber tracking using navigated brain stimulation—a feasibility study

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Abstract

Background

Navigated brain stimulation (NBS) is a newly evolving technique. In addition to its supposed purpose, e.g., preoperative mapping of the central region, little is known about its further use in neurosurgery. We evaluated the usefulness of diffusion tensor imaging fiber tracking (DTI-FT) based on NBS compared to conventional characterization of the seed region.

Methods

We examined 30 patients with tumors in or close to the corticospinal tract (CST) using NBS with the Nexstim eXimia system. NBS was performed for motor cortex mapping, and DTI-FT was performed by three different clinicians using BrainLAB iPlan® Cranial 3.0.1 at two time points. Number of fibers, tract volume, aberrant tracts, and proximity to the tumor were compared between the two methods.

Results

We recognized a higher number of fibers (1,298 ± 1,279 vs. 916 ± 986 fibers; p < 0.01), tract volume (23.0 ± 15.3 vs. 18.3 ± 14.0 cm3; p < 0.01), and aberrant tracts (0.6 ± 0.5 vs. 0.3 ± 0.5 aberrant tracts/tracked CST; p < 0.001) when the seed region was defined conventionally, while proximity of the tracts to the tumor did not differ. While NBS-based DTI-FT is independent of the planning clinician, conventional outlining of the seed region shows generally higher variability between investigators.

Conclusions

Conventional DTI-FT showed significant differences between the two modalities, most likely because of the more specific definition of the seed region when DTI-FT is based on NBS. Moreover, NBS-aided DTI fiber tracking is user-independent and, therefore, a method for further standardization of DTI fiber tracking.

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Acknowledgement

The authors want to thank Maria Becker for her continous effort in performing all MRI studies with outstanding quality and motivation parallel to her daily routine and far beyond her duty.

Disclosure

The study was completely financed by institutional grants of the Department of Neurosurgery. The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Authors and Affiliations

  1. Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Sandro M. Krieg, Niels H. Buchmann, Jens Gempt, Ehab Shiban, Bernhard Meyer & Florian Ringel

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  1. Sandro M. Krieg
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  2. Niels H. Buchmann
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  3. Jens Gempt
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  4. Ehab Shiban
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  5. Bernhard Meyer
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  6. Florian Ringel
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Correspondence to Florian Ringel.

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Krieg, S.M., Buchmann, N.H., Gempt, J. et al. Diffusion tensor imaging fiber tracking using navigated brain stimulation—a feasibility study. Acta Neurochir 154, 555–563 (2012). https://doi.org/10.1007/s00701-011-1255-3

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  • DOI: https://doi.org/10.1007/s00701-011-1255-3

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