Department of Neuroradiology, S. Andrea Hospital, University Sapienza, Rome, Italy.
Eur Radiol. 2009 Dec;19(12):2798-808. doi: 10.1007/s00330-009-1483-6.
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 presurgical 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 postsurgical 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.
(1) 评估纤维束轨迹的可能识别，(2) 检查神经导航系统在术前规划中的应用，(3) 评估术前和术后患者的临床状况，(4) 评估这些信息对手术规划和手术的影响。28 名右利手患者被前瞻性和连续研究。所有患者在术前和术后阶段均由神经科医生进行临床评估。单独重建了锥体束、视辐射和弓状束。如果在病变水平的任何层面都没有中断，那么轨迹就被认为适合手术规划。专用软件将采集的图像与轨迹处理“合并”，并将整个数据集发送到神经导航系统。对靠近肿瘤的 37 个可视化轨迹的评估导致 6 名患者（21%）的皮质切开术手术方法发生改变；在手术过程中，对肿瘤切除边界的定义产生了 64%（18 例）的影响。手术过程的总体影响百分比为 82%。在 27 例中，症状没有改变。磁共振成像-轨迹提供了神经外科医生一种新的解剖视角，对脑肿瘤的手术切除规划有影响。
