Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey.
Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey.
Eur Spine J. 2023 Dec;32(12):4321-4327. doi: 10.1007/s00586-023-07872-5. Epub 2023 Aug 2.
The aim of this study was to investigate the efficacy of diffusion tensor tractography (DTT) of spinal cord on surgical planning and postoperative neurological outcomes in patients with spinal intramedullary tumors.
The study was conducted retrospectively from the radiological and clinical data of our hospital database. Patients with intramedullary spinal cord tumors who underwent diffusion tensor imaging for spinal cord lesions were selected between 2019 and 2022. Demographic characteristics and intraoperative neurophysiological monitoring data were evaluated. The McCormick scale was used to grade the pre- and postoperative neurological status of the patients. The tumoral lesions were categorized into 3 types according to the fiber course on DTT.
Eleven patients were found to have radiological findings that were compatible with intramedullary tumor; eight (72.7%) of them ultimately underwent surgery following being approved as surgical candidates in the spinal diffusion tensor imaging studies. Six cases had Type 1, one case had Type 2, and 4 cases had Type 3 tumors according to the fiber course. All Type 1 tumors were classified as resectable and all of them were gross totally resected. Type 2 lesion that was rated as resectable by DTI was subtotally resected. Type 3 lesions were followed without surgery except the one with tumoral progression and neurological deficit. The postoperative neurological outcomes were compatible with intraoperative neurophysiological monitoring results.
Diffusion tensor imaging and tractography may be beneficial regarding the selection of patients suitable for surgery and in the subsequent surgical planning.
本研究旨在探讨脊髓弥散张量成像（DTT）在脊髓髓内肿瘤患者手术规划和术后神经功能结局中的作用。
本研究从 2019 年至 2022 年我院数据库的影像学和临床资料中进行回顾性研究。选择行脊髓弥散张量成像检查的脊髓髓内肿瘤患者。评估患者的人口统计学特征和术中神经生理监测数据。采用 McCormick 分级评估患者术前和术后的神经功能状态。根据 DTT 上的纤维束轨迹将肿瘤病变分为 3 型。
共发现 11 例患者的影像学检查结果符合髓内肿瘤，其中 8 例（72.7%）在脊髓弥散张量成像研究中被确认为手术候选者后接受了手术。根据纤维束轨迹，6 例为 1 型肿瘤，1 例为 2 型肿瘤，4 例为 3 型肿瘤。所有 1 型肿瘤均被归类为可切除肿瘤，且均行大体全切除。DTI 评定为可切除的 2 型病变行次全切除。除 1 例因肿瘤进展和神经功能缺损而未手术外，3 型病变均未行手术治疗。术后神经功能结局与术中神经生理监测结果相符。
弥散张量成像和纤维束成像可能有助于选择适合手术的患者，并在随后的手术规划中提供帮助。
