Chidambaram Swathi, Anthony Diana, Jansen Tatiana, Vigo Vera, Fernandez Miranda Juan C
Department of Neurosurgery, Stanford University, Stanford, CA, USA.
World Neurosurg X. 2023 Jun 23;20:100226. doi: 10.1016/j.wnsx.2023.100226. eCollection 2023 Oct.
Augmented reality (AR) has been found to be advantageous in enhancing visualization of complex neuroanatomy intraoperatively and in neurosurgical education. Another key tool that allows neurosurgeons to have enhanced visualization, namely of white matter tracts, is diffusion tensor imaging (DTI) that is processed with high-definition fiber tractography (HDFT). There remains an enduring challenge in the structural-functional correlation of white matter tracts that centers on the difficulty in clearly assigning function to any given fiber tract when evaluating them through separated as opposed to integrated modalities. Combining the technologies of AR with fiber tractography shows promise in helping to fill in this gap between structural-functional correlation of white matter tracts. This novel study demonstrates through a series of three cases of awake craniotomies for glioma resections a technique that allows the first and most direct evidence of fiber tract stimulation and assignment of function or deficit in vivo through the intraoperative, real-time fusion of electrical cortical stimulation, AR, and HDFT. This novel technique has qualitatively shown to be helpful in guiding intraoperative decision making on extent of resection of gliomas. Future studies could focus on larger, prospective cohorts of glioma patients who undergo this methodology and further correlate the post-operative imaging results to patient functional outcomes.
增强现实(AR)已被证明在术中增强复杂神经解剖结构的可视化以及神经外科教育方面具有优势。另一种使神经外科医生能够增强可视化的关键工具,即白质束的可视化,是通过高清纤维束成像(HDFT)处理的扩散张量成像(DTI)。在白质束的结构 - 功能相关性方面,仍然存在一个持久的挑战,其核心在于当通过分离而非整合的方式评估任何给定纤维束时,难以明确赋予其功能。将AR技术与纤维束成像相结合,有望填补白质束结构 - 功能相关性之间的这一空白。这项新研究通过一系列三例清醒开颅胶质瘤切除术展示了一种技术,该技术通过术中实时融合电皮质刺激、AR和HDFT,首次提供了体内纤维束刺激以及功能或功能缺陷分配的最直接证据。这项新技术已定性地证明有助于指导胶质瘤切除范围的术中决策。未来的研究可以集中在接受这种方法的更大规模的前瞻性胶质瘤患者队列上,并进一步将术后成像结果与患者功能结果相关联。
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