Department of Neurosurgery, University of Marburg, Marburg, Germany.
Neurosurgery. 2012 Apr;70(4):911-9; discussion 919-20. doi: 10.1227/NEU.0b013e318237a807.
For neuroepithelial tumors, the surgical goal is maximum resection with preservation of neurological function. This is contributed to by intraoperative magnetic resonance imaging (iMRI) combined with multimodal navigation.
We evaluated the contribution of diffusion tensor imaging (DTI)-based fiber tracking of language pathways with 2 different algorithms (tensor deflection, connectivity analysis [CA]) integrated in the navigation on the surgical outcome.
We evaluated 32 patients with neuroepithelial tumors who underwent surgery with DTI-based fiber tracking of language pathways integrated in neuronavigation. The tensor deflection algorithm was routinely used and its results intraoperatively displayed in all cases. The CA algorithm was furthermore evaluated in 23 cases. Volumetric assessment was performed in pre- and intraoperative MR images. To evaluate the benefit of fiber tractography, language deficits were evaluated pre- and postoperatively and compared with the volumetric analysis.
Final gross-total resection was performed in 40.6% of patients. Absolute tumor volume was reduced from 55.33 ± 63.77 cm(3) to 20.61 ± 21.67 cm(3) in first iMRI resection control, to finally 11.56 ± 21.92 cm(3) (P < .01). Fiber tracking of the 2 algorithms showed a deviation of the displayed 3D objects by <5 mm. In long-term follow-up only 1 patient (3.1%) had a persistent language deficit.
Intraoperative visualization of language-related cortical areas and the connecting pathways with DTI-based fiber tracking can be successfully performed and integrated in the navigation system. In a setting of intraoperative high-field MRI this contributes to maximum tumor resection with low postoperative morbidity.
对于神经上皮肿瘤，手术目标是在保留神经功能的情况下进行最大限度的切除。这得益于术中磁共振成像（iMRI）与多模态导航相结合。
我们评估了基于弥散张量成像（DTI）的语言通路纤维追踪与 2 种不同算法（张量偏折、连通性分析[CA]）相结合在导航中的应用对手术结果的贡献。
我们评估了 32 例接受神经上皮肿瘤手术的患者，这些患者的手术均采用基于 DTI 的语言通路纤维追踪与神经导航相结合。常规使用张量偏折算法，所有病例均在术中显示其结果。此外，还评估了 CA 算法在 23 例患者中的应用。在术前和术中磁共振成像上进行了体积评估。为了评估纤维束追踪的益处，我们在术前和术后评估了语言缺陷，并与体积分析进行了比较。
最终行大体全切除的患者占 40.6%。绝对肿瘤体积从术前的 55.33±63.77cm³在首次 iMRI 切除控制时减少到 20.61±21.67cm³，最终减少到 11.56±21.92cm³（P＜0.01）。2 种算法的纤维追踪显示，显示的 3D 对象的偏差＜5mm。在长期随访中，仅有 1 例患者（3.1%）存在持续性语言缺陷。
基于 DTI 的纤维追踪技术可成功实现并整合到导航系统中，术中可视化语言相关皮质区及其连接通路。在术中高场强 MRI 的情况下，这有助于最大限度地切除肿瘤，同时降低术后发病率。
