Rueckriegel Stefan Mark, Linsenmann Thomas, Kessler Almuth Friederike, Homola György A, Bartsch Andreas J, Ernestus Ralf-Ingo, Westermaier Thomas, Löhr Mario
Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany.
Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany.
World Neurosurg. 2016 Jun;90:306-314. doi: 10.1016/j.wneu.2016.02.119. Epub 2016 Mar 9.
Surgical resection of intra-axial tumors is a challenging procedure because of indistinct tumor margins, infiltration, and displacement of white matter tracts surrounding the lesion. Hence, gross total tumor resection without causing new neurologic deficits is demanding, especially in tumor sites adjoining eloquent structures. Feasibility of the combination of navigated probabilistic fiber tracking to identify eloquent fiber pathways and navigated ultrasonography to control brain shift was tested.
Eleven patients with lesions adjacent to eloquent white matter structures (pyramidal tract, optic radiation and arcuate fascicle) were preoperatively subjected to magnetic resonance imaging including diffusion-weighted imaging on a 3-T magnetic resonance system (Trio [Siemens, Erlangen, Germany]). Probabilistic fiber tracking was performed using the tools of the FMRIB Software Library (FSL). Results of probabilistic fiber tracking and high-resolution anatomic images were integrated into the neuronavigation system Stealth Station (Medtronic, Minneapolis, Minnesota, USA) together with the navigated ultrasonography (SonoNav [Medtronic]).
FSL-based probabilistic fiber tracking depicted the pyramidal tract, the optic radiation, and arcuate fascicle anatomically plausibly. Integration of the probabilistic fiber tracking into neuronavigation was technically feasible and allowed visualization of the reconstructed fiber pathways. Navigated ultrasonography controlled brain shift.
Integration of probabilistic fiber tracking and navigated ultrasonography into intraoperative neuronavigation facilitated anatomic orientation during glioma resection. FSL-based probabilistic fiber tracking integrated sophisticated fiber tracking algorithms, including modeling of crossing fibers. Combination with navigated ultrasonography provided a three-dimensional estimation of intraoperative brain shift and, therefore, improved the reliability of neuronavigation.
由于轴内肿瘤边界不清、浸润以及病变周围白质束移位，对其进行手术切除具有挑战性。因此，在不引起新的神经功能缺损的情况下实现肿瘤全切很困难，尤其是在毗邻明确功能结构的肿瘤部位。本研究测试了将导航概率纤维束示踪技术用于识别明确功能纤维束以及将导航超声用于控制脑移位二者联合应用的可行性。
11例病变毗邻明确功能白质结构（锥体束、视辐射和弓状束）的患者，术前在3-T磁共振系统（Trio [西门子，埃尔朗根，德国]）上进行包括弥散加权成像在内的磁共振成像检查。使用FMRIB软件库（FSL）工具进行概率纤维束示踪。概率纤维束示踪结果和高分辨率解剖图像与导航超声（SonoNav [美敦力公司]）一起整合到神经导航系统Stealth Station（美敦力公司，明尼阿波利斯，明尼苏达州，美国）中。
基于FSL的概率纤维束示踪在解剖学上合理地显示了锥体束、视辐射和弓状束。将概率纤维束示踪整合到神经导航在技术上是可行的，并且能够可视化重建的纤维束路径。导航超声可控制脑移位。
将概率纤维束示踪和导航超声整合到术中神经导航中有助于胶质瘤切除术中的解剖定位。基于FSL的概率纤维束示踪整合了复杂的纤维束示踪算法，包括交叉纤维建模。与导航超声相结合可提供术中脑移位的三维估计，从而提高神经导航的可靠性。
