Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany.
Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2020 Sep;81(5):442-455. doi: 10.1055/s-0039-1691823. Epub 2020 Mar 16.
The ability to visualize the brain's fiber connections noninvasively in vivo is relatively young compared with other possibilities of functional magnetic resonance imaging. Although many studies showed tractography to be of promising value for neurosurgical care, the implications remain inconclusive. An overview of current applications is presented in this systematic review. A search was conducted for (("tractography" or "fiber tracking" or "fibre tracking") and "neurosurgery") that produced 751 results. We identified 260 relevant articles and added 20 more from other sources. Most publications concerned surgical planning for resection of tumors ( = 193) and vascular lesions ( = 15). Preoperative use of transcranial magnetic stimulation was discussed in 22 of these articles. Tractography in skull base surgery presents a special challenge ( = 29). Fewer publications evaluated traumatic brain injury (TBI) ( = 25) and spontaneous intracranial bleeding ( = 22). Twenty-three articles focused on tractography in pediatric neurosurgery. Most authors found tractography to be a valuable addition in neurosurgical care. The accuracy of the technique has increased over time. There are articles suggesting that tractography improves patient outcome after tumor resection. However, no reliable biomarkers have yet been described. The better rehabilitation potential after TBI and spontaneous intracranial bleeding compared with brain tumors offers an insight into the process of neurorehabilitation. Tractography and diffusion measurements in some studies showed a correlation with patient outcome that might help uncover the neuroanatomical principles of rehabilitation itself. Alternative corticofugal and cortico-cortical networks have been implicated in motor recovery after ischemic stroke, suggesting more complex mechanisms in neurorehabilitation that go beyond current models. Hence tractography may potentially be able to predict clinical deficits and rehabilitation potential, as well as finding possible explanations for neurologic disorders in retrospect. However, large variations of the results indicate a lack of data to establish robust diagnostical concepts at this point. Therefore, in vivo tractography should still be interpreted with caution and by experienced surgeons.
与其他功能磁共振成像的可能性相比，非侵入性地在体内可视化大脑纤维连接的能力相对较新。尽管许多研究表明追踪轨迹对于神经外科护理具有很大的价值，但结果仍不确定。本文对当前的应用进行了综述。我们进行了一次检索，使用了("tractography" 或 "fiber tracking" 或 "fibre tracking") 和 "neurosurgery"，产生了 751 个结果。我们确定了 260 篇相关文章，并从其他来源增加了 20 篇。大多数出版物涉及肿瘤切除（ = 193）和血管病变（ = 15）的手术计划。其中 22 篇文章讨论了经颅磁刺激的术前应用。颅底手术中的追踪轨迹提出了一个特殊的挑战（ = 29）。创伤性脑损伤（TBI）（ = 25）和自发性颅内出血（ = 22）的出版物较少。23 篇文章专注于儿科神经外科中的追踪轨迹。大多数作者认为追踪轨迹是神经外科护理的有价值的补充。该技术的准确性随着时间的推移而提高。有一些文章表明，追踪轨迹可以改善肿瘤切除后的患者预后。然而，尚未描述可靠的生物标志物。与脑肿瘤相比，TBI 和自发性颅内出血的康复潜力更好，这为神经康复过程提供了一个洞察。在一些研究中，追踪轨迹和扩散测量与患者预后相关，这可能有助于揭示康复本身的神经解剖学原则。在缺血性中风后，替代的皮质传出和皮质皮质网络与运动恢复有关，这表明神经康复中的机制更为复杂，超越了当前的模型。因此，追踪轨迹可能能够预测临床缺陷和康复潜力，并为回顾性神经障碍找到可能的解释。然而，结果的巨大差异表明目前缺乏建立稳健诊断概念的数据。因此，在体内追踪轨迹仍然应该由经验丰富的外科医生谨慎解读。
