Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Medtronic, Dublin, Ireland.
Oper Neurosurg (Hagerstown). 2017 Feb 1;13(1):47-59. doi: 10.1227/NEU.0000000000001181.
Use of diffusion tensor imaging (DTI) in brain tumor resection has been limited in part by a perceived difficulty in implementing the techniques into neurosurgical practice.
To demonstrate a simple DTI postprocessing method performed without a neuroscientist and to share results in preserving patient function while aggressively resecting tumors.
DTI data are obtained in all patients with tumors located within presumed eloquent cortices. Relevant white matter tracts are mapped and integrated with neuronavigation by a nonexpert in < 20 minutes. We report operative results in 43 consecutive awake craniotomy patients from January 2014 to December 2014 undergoing resection of intracranial lesions. We compare DTI-expected findings with stimulation mapping results for the corticospinal tract, superior longitudinal fasciculus, and inferior fronto-occipital fasciculus.
Twenty-eight patients (65%) underwent surgery for high-grade gliomas and 11 patients (26%) for low-grade gliomas. Seventeen patients had posterior temporal lesions; 10 had posterior frontal lesions; 8 had parietal-temporal-occipital junction lesions; and 8 had insular lesions. With DTI-defined tracts used as a guide, a combined 65 positive maps and 60 negative maps were found via stimulation mapping. Overall sensitivity and specificity of DTI were 98% and 95%, respectively. Permanent speech worsening occurred in 1 patient (2%), and permanent weakness occurred in 3 patients (7%). Greater than 90% resection was achieved in 32 cases (74%).
Accurate DTI is easily obtained, postprocessed, and implemented into neuronavigation within routine neurosurgical workflow. This information aids in resecting tumors while preserving eloquent cortices and subcortical networks.
扩散张量成像（DTI）在脑肿瘤切除中的应用受到一定限制，部分原因是将这些技术应用于神经外科实践存在一定难度。
展示一种无需神经科学家参与的简单 DTI 后处理方法，并分享在积极切除肿瘤的同时保留患者功能的结果。
在所有肿瘤位于推测的功能区皮质内的患者中均获取 DTI 数据。通过非专业人员在 <20 分钟内完成相关白质束的映射并与神经导航集成。我们报告了 2014 年 1 月至 2014 年 12 月期间接受颅内病变切除术的 43 例连续清醒开颅手术患者的手术结果。我们将 DTI 预期结果与皮质脊髓束、上纵束和下额枕束的刺激图结果进行比较。
28 例（65%）患者因高级别胶质瘤而行手术，11 例（26%）患者因低级别胶质瘤而行手术。17 例患者病变位于颞叶后部；10 例患者病变位于额叶后部；8 例患者病变位于顶叶-颞叶-枕叶交界处；8 例患者病变位于岛叶。通过刺激图发现，利用 DTI 定义的束作为指导，共发现 65 个阳性图和 60 个阴性图。DTI 的总体敏感性和特异性分别为 98%和 95%。1 例患者（2%）出现永久性言语恶化，3 例患者（7%）出现永久性无力。32 例（74%）患者达到>90%的肿瘤切除率。
准确的 DTI 可以在常规神经外科工作流程中轻松获取、后处理并应用于神经导航。这些信息有助于在切除肿瘤的同时保留功能区皮质和皮质下网络。
