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Utility of diffusion tensor-imaged (DTI) motor fiber tracking for the resection of intracranial tumors near the corticospinal tract

  • Clinical Article
  • Published:
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Abstract

Purpose

Treatment of intracranial tumors near the corticospinal tract remains a surgical challenge. Several technical tools to map and monitor the motor tract have been implemented. The present study aimed to assess the utility of diffusion tensor imaging (DTI) fiber tracking in the surgical treatment of motor eloquent tumors at our institution.

Methods

Patients operated for intracranial tumors close to the motor tract with the use of intraoperative image guidance including DTI fiber tracking of the corticospinal tract and intraoperative motor evoked potential (MEP) monitoring were analyzed. The intraoperative utility of fiber tracking data was analyzed. Furthermore, preoperative MRI scans with and without motor fiber tracking were reevaluated post hoc for tumor relation to the motor tract, estimated resectability, and best approach. Thereby, the utility of fiber tracking in surgical planning was assessed.

Results

Nineteen patients were analyzed. The estimation of tumor localization in relation to the motor tract and of resectability was not influenced by fiber tracking in any of the cases. Only in one single case did evaluating surgeons change their surgical approach after the addition of the fiber tracking data. In all cases, fiber tracking included in image guidance did not change the intraoperative strategy, while MEP monitoring did.

Conclusions

DTI fiber tracking did not influence the surgical planning or the intraoperative course. However, it is still used at our institution due to its ease in acquisition and its potential impact in a larger series. Furthermore, more experience with this technique is required to lead to a technical improvement.

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Acknowledgments

We are indebted to Doris Droese for her support in IONM.

Financial disclosure

The authors have no financial interest in the subject under discussion nor did they receive any financial support for the present study.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany

    Niels Buchmann, Jens Gempt, Michael Stoffel, Annette Foerschler, Bernhard Meyer & Florian Ringel

Authors
  1. Niels Buchmann
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  2. Jens Gempt
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  3. Michael Stoffel
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  4. Annette Foerschler
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  5. Bernhard Meyer
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  6. Florian Ringel
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Corresponding author

Correspondence to Florian Ringel.

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Comment

The authors performed preoperative DTI fiber tracking of the pyramidal pathway in 19 patients who underwent surgery for brain tumor, with the goal to assess the utility of this new method. They showed that DTI did not influence the surgical planning or the intraoperative course.

The authors have to be congratulated for this important message. Indeed, the aim and the methodology of this study are original, especially regarding the reevaluation post hoc for tumor relation to the motor tract, estimated resectability, and best approach. Very few data are currently available about the actual impact of DTI on surgical planning. On the basis of these results, it is important for neurosurgeons to not forget the both methodological and practical limitations of DTI and thus the need to continue to use intraoperative electrophysiological monitoring and mapping near eloquent structures. It is already known that, beyond its fundamental interest (better understanding of brain connectivity), DTI has to be validated before to be incorporated as a reliable tool in the clinical practice. In addition, Buchmann et al. now show that the actual contribution of DTI for brain surgery (preoperative planning as well as intraoperative course) remains also to be demonstrated.

Hugues Duffau

Montpellier, France

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Buchmann, N., Gempt, J., Stoffel, M. et al. Utility of diffusion tensor-imaged (DTI) motor fiber tracking for the resection of intracranial tumors near the corticospinal tract. Acta Neurochir 153, 68–74 (2011). https://doi.org/10.1007/s00701-010-0817-0

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  • DOI: https://doi.org/10.1007/s00701-010-0817-0

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