Freyschlag C F, Kerschbaumer J, Pinggera D, Bodner T, Grams A E, Thomé C
Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Brain Inform. 2017 Sep;4(3):201-205. doi: 10.1007/s40708-017-0064-8. Epub 2017 May 4.
For surgery of eloquent tumors in language areas, the accepted gold standard is functional mapping through direct cortical stimulation (DCS) in awake patients. Ever since, neuroscientists are searching for reliable noninvasive detection of function in the human brain, with variable success. The potential of diffusion tensor imaging (DTI) in combination with computational cortical parcellation to predict functional areas in language eloquent tumors has not been assessed so far. We present a proof-of-concept report involving awake surgery for a temporodorsal tumor. Postoperatively, the imaging was extensively studied and a predictive value of multimodal MR imaging for the possible extent of resection was analyzed. After resection using DCS, the extent of resection and functional outcome were correlated with the processed imaging. Preoperative imaging of our patient was taken to compute the lesion volume as a seed for tractography (DTI) and combined with a tractography of the entire hemisphere. For better spatial resolution, an elastic image fusion was performed to correct the distortion of DTI data. After subtotal resection and imaging analysis, the status of the superior part of the lesion could be identified and predicted as functional cortex. There was a strong correlation between the tumor remnant during surgery and the imaging parameters of DTI connectivity of the eloquent tissue. A combination of complex DTI processing may be able to predict function in a patient suffering eloquent brain tumors and thus allow estimation of extent of resection.
对于语言区明确肿瘤的手术，公认的金标准是在清醒患者中通过直接皮质刺激（DCS）进行功能图谱绘制。从那时起，神经科学家们一直在寻找可靠的无创检测人脑功能的方法，但成效不一。到目前为止，尚未评估扩散张量成像（DTI）结合计算性皮质分区来预测语言明确肿瘤功能区的潜力。我们展示了一份关于颞背侧肿瘤清醒手术的概念验证报告。术后，对成像进行了广泛研究，并分析了多模态磁共振成像对可能的切除范围的预测价值。在使用DCS进行切除后，将切除范围和功能结果与处理后的成像进行关联。对我们的患者进行术前成像以计算病变体积作为纤维束成像（DTI）的种子，并与整个半球的纤维束成像相结合。为了获得更好的空间分辨率，进行了弹性图像融合以校正DTI数据的失真。在次全切除和成像分析后，可以识别并预测病变上部为功能皮质。手术期间肿瘤残余与明确组织的DTI连通性成像参数之间存在很强的相关性。复杂的DTI处理组合可能能够预测患有明确脑肿瘤患者的功能，从而估计切除范围。
