Yonsei Med J.  2014 Sep;55(5):1303-1309. 10.3349/ymj.2014.55.5.1303.

Clinical Use of Diffusion Tensor Image-Merged Functional Neuronavigation for Brain Tumor Surgeries: Review of Preoperative, Intraoperative, and Postoperative Data for 123 Cases

• Cho JM
• Kim EH
• Kim J
• Lee SK
• Kim SH
• Lee KS
• Chang JH

• KMID: 1799495
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1303

Abstract

PURPOSE
To achieve maximal safe resection during brain tumor surgery, functional image-merged neuronavigation is widely used. We retrospectively reviewed our cases in which diffusion tensor image (DTI)-merged functional neuronavigation was performed during surgery.
MATERIALS AND METHODS
Between November 2008 and May 2010, 123 patients underwent surgery utilizing DTI-merged neuronavigation. Anatomical magnetic resonance images (MRI) were obtained preoperatively and fused with DTI of major white matter tracts, such as the corticospinal tract, optic radiation, or arcuate fasciculus. We used this fused image for functional neuronavigation during brain tumor surgery of eloquent areas. We checked the DTI images together with postoperative MRI images and evaluated the integrity of white matter tracts.
RESULTS
A single white matter tract was inspected in 78 patients, and two or more white matter tracts were checked in 45 patients. Among the 123 patients, a grossly total resection was achieved in 90 patients (73.2%), subtotal resection in 29 patients (23.6%), and partial resection in 4 patients (3.3%). Postoperative neurologic outcomes, compared with preoperative function, included the following: 100 patients (81.3%) displayed improvement of neurologic symptoms or no change, 7 patients (5.7%) experienced postoperative permanent neurologic deterioration (additional or aggravated neurologic symptoms), and 16 patients (13.0%) demonstrated transient worsening.
CONCLUSION
DTI-merged functional neuronavigation could be a useful tool in brain tumor surgery for maximal safe resection. However, there are still limitations, including white matter tract shift, during surgery and in DTI itself. Further studies should be conducted to overcome these limitations.

Keyword

Diffusion tensor image; navigation; brain tumor; tractography

MeSH Terms

Adolescent
Adult
Aged
Brain Neoplasms/pathology/*surgery
*Diffusion Tensor Imaging
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
*Neuronavigation
Neurosurgical Procedures/*methods
Postoperative Period
Preoperative Period
Retrospective Studies

Figure

• 

  Fig. 1 Thirty-six-year old male patient with an anaplastic astrocytoma at the left insula. The tumor mass shows poorly demarcated high signal intensity on T2-weighted MR images (A) and low signal intensity on T1-weighted MR images (B). During preoperative surgical planning (C), the arcuate fasciculus (red) was suspicious of partly passing through the tumor mass (purple) and the corticospinal tract (yellow) was surrounding the mass. When the superior part of the tumor was resected in an awake state (D), aphasia developed, and we stopped further resection of the tumor. Postoperative MRI with diffusion tensor image shows small remnants of tumor and a well preserved arcuate fasciculus (E).

• 

  Fig. 2 Eighteen-year-old female patient with a pilocytic astrocytoma. The preoperative T1-weighted MR image shows a well enhanced cystic mass at the right occipital area (A). Navigation snap shot image (B) during operation reveals that the optic radiation is passing the medial margin of the tumor. Postoperative MRI with diffusion tensor image shows completely resected tumor and a well preserved optic radiation (C).

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