Küpper Hanna, Groeschel Samuel, Alber Michael, Klose Uwe, Schuhmann Martin U, Wilke Marko
Pediatric Neurology and Developmental Medicine, University of Tübingen, Tübingen, Germany.
Department of Neuroradiology, Radiological Clinic, University of Tübingen, Tübingen, Germany.
Neuropediatrics. 2015 Feb;46(1):72-5. doi: 10.1055/s-0034-1395346. Epub 2014 Dec 23.
Advanced modalities such as functional magnetic resonance imaging (MRI) and diffusion MR tractography offer in vivo information about brain networks and are therefore increasingly used for neurosurgical planning in children also.
This study aims to study the application of routine and advanced tractography algorithms and its comparison with intraoperative subcortical electrical stimulation.
Presurgical functional MRI and MR diffusion tractography were performed on a 6-year-old patient presenting with seizures, but no motor symptoms, due to a neuroectodermal tumor in the left central region. Three different tractography algorithms were compared: deterministic diffusion tensor imaging (DTI)-tracking, probabilistic DTI-tracking, and probabilistic constrained spherical deconvolution tracking (pCSD).
All three tractography algorithms could localize the core of the corticospinal tract with good agreement. The pCSD-tracking algorithm was more sensitive in revealing the anatomically most realistic fiber distribution and a proportion of fibers traversing a solid part of the tumor. Intraoperative stimulation confirmed these fibers close to the tumor. As a result, only a subtotal resection was performed, preventing postoperative sensorimotor deficits.
Although, all tractography algorithms successfully identified the core of the corticospinal pathway, deterministic DTI-tractography, as widely used in clinical neuronavigation software, only insufficiently visualized critical fibers here. We believe these results argue for a stronger consideration of advanced tractography approaches in neurosurgical planning.
功能磁共振成像（MRI）和磁共振扩散张量纤维束成像等先进技术能够提供有关脑网络的活体信息，因此在儿童神经外科手术规划中也越来越常用。
本研究旨在探讨常规和先进的纤维束成像算法的应用，并将其与术中皮质下电刺激进行比较。
对一名6岁因左侧中央区神经外胚层肿瘤导致癫痫发作但无运动症状的患者进行术前功能MRI和磁共振扩散张量纤维束成像。比较了三种不同的纤维束成像算法：确定性扩散张量成像（DTI）追踪、概率性DTI追踪和概率性约束球面反卷积追踪（pCSD）。
所有三种纤维束成像算法都能很好地定位皮质脊髓束的核心。pCSD追踪算法在揭示解剖学上最真实的纤维分布以及穿过肿瘤实体部分的一部分纤维方面更敏感。术中刺激证实了靠近肿瘤的这些纤维。因此，仅进行了次全切除，预防了术后感觉运动功能障碍。
尽管所有纤维束成像算法都成功识别了皮质脊髓通路的核心，但临床神经导航软件中广泛使用的确定性DTI纤维束成像在此处仅不足以显示关键纤维。我们认为这些结果支持在神经外科手术规划中更加强烈地考虑先进的纤维束成像方法。
