Department of Neurosurgery and Gamma Knife Radiosurgery, PD Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400016, India.
J Clin Neurosci. 2011 May;18(5):633-9. doi: 10.1016/j.jocn.2010.08.026. Epub 2011 Mar 2.
We aimed to assess the role of preoperative diffusion tensor tractography (DTT) in the surgical planning and prognostication of the postoperative outcome of patients with lesions in the eloquent areas of the brain. From 2006 to 2009, 50 patients were preoperatively evaluated with DTT and image-guidance studies. Three-dimensional (3D) color trajectory maps of white-matter tracts adjacent to the lesions were reconstructed. The usefulness of tractography in perioperative planning was graded on a scale of 1 to 4. The postoperative outcomes were studied in relation to the pattern of tract involvement. The lesions included brain tumors in 40 patients, vascular malformations in five patients and other lesions in five patients. An awake craniotomy was performed in 19 patients. The tracts were only displaced in 72% of patients, completely infiltrated in 14% and had a combined pattern in 14%. DTT significantly altered the planning (score ≥ 3) in 62% of patients. Patients with pure displacement had the best outcome, while those with infiltration had a poorer outcome. We conclude that tractography improves surgical safety and aids prognostication in surgery of patients with eloquent cortex lesions.
我们旨在评估术前弥散张量纤维束成像（DTT）在评估病变位于脑功能区患者的手术规划和术后预后中的作用。2006 年至 2009 年，50 例患者接受了 DTT 和影像引导研究的术前评估。重建了与病变相邻的白质束的三维（3D）彩色轨迹图。根据 1 到 4 的评分量表评估纤维束成像在围手术期规划中的有用性。术后结果与纤维束受累模式相关。病变包括 40 例脑肿瘤、5 例血管畸形和 5 例其他病变。19 例患者接受了清醒开颅手术。只有 72%的患者的束移位，14%的患者完全浸润，14%的患者合并存在。DTT 显著改变了 62%患者的手术规划（评分≥3）。仅有移位的患者预后最好，而浸润的患者预后较差。我们得出结论，纤维束成像可提高手术安全性并有助于预测语言皮质病变患者的手术预后。
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