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Morrison MA, Tam F, Garavaglia MM, Hare GMT, Cusimano MD, Schweizer TA, Das S, Graham SJ. Sources of Variation Influencing Concordance between Functional MRI and Direct Cortical Stimulation in Brain Tumor Surgery. Front Neurosci 2016; 10:461. [PMID: 27803645 PMCID: PMC5067437 DOI: 10.3389/fnins.2016.00461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/26/2016] [Indexed: 11/13/2022] Open
Abstract
Object: Preoperative functional magnetic resonance imaging (fMRI) remains a promising method to aid in the surgical management of patients diagnosed with brain tumors. For patients that are candidates for awake craniotomies, surgical decisions can potentially be improved by fMRI but this depends on the level of concordance between preoperative brain maps and the maps provided by the gold standard intraoperative method, direct cortical stimulation (DCS). There have been numerous studies of the concordance between fMRI and DCS using sensitivity and specificity measures, however the results are variable across studies and the key factors influencing variability are not well understood. Thus, the present work addresses the influence of technical factors on fMRI and DCS concordance. Methods: Motor and language mapping data were collected for a group of glioma patients (n = 14) who underwent both preoperative fMRI and intraoperative DCS in an awake craniotomy procedure for tumor removal. Normative fMRI data were also acquired in a healthy control group (n = 12). The fMRI and DCS mapping data were co-registered; true positive (TP), true negative (TN), false positive (FP), and false negative (FN) occurrences were tabulated over the exposed brain surface. Sensitivity and specificity were measured for the total group, and for the motor and language sub-groups. The influence of grid placement, fMRI statistical thresholding, and task standardization were assessed. Correlations between proportions of agreement and error were also carefully scrutinized to evaluate concordance in more detail. Results: Concordance was significantly better for motor vs. language mapping. There was an inverse relationship between TP and TN with increasing statistical threshold, and FP dominated the total error. Sensitivity and specificity were reduced when tasks were not standardized across fMRI and DCS. Conclusions: Although the agreement between fMRI and DCS is good, variability is introduced by technical factors that can diminish the quality of patient data. Neurosurgeons should evaluate the usefulness of fMRI data while considering that (a) discordance arises primarily from FP fMRI results; (b) there is an inherent trade-off between sensitivity and specificity with fMRI statistical threshold; and
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Affiliation(s)
- Melanie A. Morrison
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
| | - Fred Tam
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
| | - Marco M. Garavaglia
- Department of Anaesthesia, University of TorontoToronto, ON, Canada
- Department of Anaesthesia, Toronto Western HospitalToronto, ON, Canada
| | - Gregory M. T. Hare
- Department of Anaesthesia, University of TorontoToronto, ON, Canada
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Department of Anaesthesia, St. Michael's HospitalToronto, ON, Canada
| | - Michael D. Cusimano
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Division of Neurosurgery, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Tom A. Schweizer
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Sunit Das
- Keenan Research Centre, St. Michael's HospitalToronto, ON, Canada
- Division of Neurosurgery, St. Michael's HospitalToronto, ON, Canada
- Department of Surgery, University of TorontoToronto, ON, Canada
| | - Simon J. Graham
- Physical Sciences Platform, Sunnybrook Research InstituteToronto, ON, Canada
- Department of Medical Biophysics, University of TorontoToronto, ON, Canada
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Ius T, Turella L, Pauletto G, Isola M, Maieron M, Sciacca G, Budai R, D'Agostini S, Eleopra R, Skrap M. Quantitative Diffusion Tensor Imaging Analysis of Low-Grade Gliomas: From Preclinical Application to Patient Care. World Neurosurg 2016; 97:333-343. [PMID: 27744082 DOI: 10.1016/j.wneu.2016.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Preoperative diffusion tensor tractography (DTT) has recently been used to aid in the mapping of functional pathways to limit damage associated with resection of low-grade gliomas (LGGs). OBJECTIVE To assess the predictive capacity of DTT as a biomarker of postoperative motor outcomes in patients with LGGs involving the corticospinal tract (CST). CST parameters obtained using a quantitative fiber tracking approach were used to investigate the reliability of the DTT biomarker by comparing their values in the tumoral (Tcst) and healthy (Hcst) hemispheres. METHODS Thirty-seven patients with LGGs involving the CST were enrolled. Quantification of structural differences between the Tcst and Hcst were analyzed according to the novel biomarker (NF index), defined as follows: (Hcst NF - Tcst NF)/Hcst NF, where NF represents the number of fibers in each region. Logistic regression analysis was used to examine associations among clinical postoperative outcomes and NF index values, tumoral patterns, and premotor/motor evoked potentials. RESULTS NF values significantly differed between the Tcst and Hcst. Analysis of the NF index showed that patients with a preoperative NF index <0.22 had a significantly lower risk of developing transient postoperative deficits (area under the curve, 0.92; 95% binomial confidence interval, 0.834-1). Patients with less pronounced differences in NF between the Tcst and Hcst also experienced better clinical outcomes. CONCLUSIONS The NF index may be a useful biomarker for predicting clinical outcomes in patients with LGGs. Furthermore, the NF index may provide a preoperative estimate of the patient's potential for recovery from possible postsurgical neurologic deficits.
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Affiliation(s)
- Tamara Ius
- Department of Neurosurgery, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy.
| | - Luca Turella
- CIMeC - Center for Mind/Brain Sciences, University of Trento, Trento, Italy
| | - Giada Pauletto
- Department of Neurology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Miriam Isola
- Department of Medical and Biological Sciences, Section of Statistics, University of Udine, Udine, Italy
| | - Marta Maieron
- Department of Physics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Giovanni Sciacca
- Department of Neurosurgery, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Riccardo Budai
- Department of Neurology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Serena D'Agostini
- Department of Neuroradiology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Roberto Eleopra
- Department of Neurology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Miran Skrap
- Department of Neurosurgery, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
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Abdullah A, El Shitany H, Abbass W, Safwat A, Elsamman AK, El Refaee E. Surgical resection of low-grade gliomas in eloquent areas with the guidance of the preoperative functional magnetic resonance imaging and craniometric points. J Neurosci Rural Pract 2016; 7:571-576. [PMID: 27695239 PMCID: PMC5006471 DOI: 10.4103/0976-3147.188629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: Surgical resection of low-grade gliomas (LGGs) in eloquent areas is one of the challenges in neurosurgery, using assistant tools to facilitate effective excision with minimal postoperative neurological deficits has been previously discussed (awake craniotomy and intraoperative cortical stimulation); however, these tools could have their own limitations thus implementation of a simple and effective technique that can guide to safe excision is needed in many situations. Materials and Methods: The authors conducted a retrospective analysis of a prospectively collected data of 76 consecutive surgical cases of LGGs of these 21 cases were situated in eloquent areas. Preoperative functional magnetic resonance imaging (fMRI), pre- and post-operative MRI with volumetric analysis of the tumor size was conducted, and intraoperative determination of the craniometric points related to the tumor (navigation guided in 10 cases) were studied to evaluate the effectiveness of the aforementioned tools in safe excision of the aforementioned tumors. Results: Total-near total excision in 14 (66.67%) subtotal in 6 (28.57%), and biopsy in 1 case (4.57%). In long-term follow–up, only one case experienced persistent dysphasia. Conclusion: In spite of its simplicity, the identification of the safe anatomical landmarks guided by the preoperative fMRI is a useful technique that serves in safe excision of LGGs in eloquent areas. Such technique can replace intraoperative evoked potentials or the awake craniotomy in most of the cases. However, navigation-guided excision might be crucial in deeply seated and large tumors to allow safe and radical excision.
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Affiliation(s)
- Ahmed Abdullah
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | - Waleed Abbass
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | - Amr Safwat
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | - Amr K Elsamman
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | - Ehab El Refaee
- Department of Neurosurgery, Cairo University, Cairo, Egypt
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Marini A, Galetto V, Tatu K, Duca S, Geminiani G, Sacco K, Zettin M. Recovering two languages with the right hemisphere. BRAIN AND LANGUAGE 2016; 159:35-44. [PMID: 27289209 DOI: 10.1016/j.bandl.2016.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 02/26/2016] [Accepted: 05/28/2016] [Indexed: 06/06/2023]
Abstract
Converging evidence suggests that the right hemisphere (RH) plays an important role in language recovery from aphasia after a left hemisphere (LH) lesion. In this longitudinal study we describe the neurological, cognitive, and linguistic profile of A.C., a bilingual who, after a severe traumatic brain injury, developed a form of fluent aphasia that affected his two languages (i.e., Romanian and Italian). The trauma-induced parenchymal atrophy led to an exceptional ventricular dilation that, gradually, affected the whole left hemisphere. A.C. is now recovering both languages relying only on his right hemisphere. An fMRI experiment employing a bilingual covert verb generation task documented the involvement of the right middle temporal gyrus in processes of lexical selection and access. This case supports the hypothesis that the RH plays a role in language recovery from aphasia when the LH has suffered massive lesions.
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Affiliation(s)
- Andrea Marini
- Dipartimento di Lingue e Letterature, Comunicazione, Formazione e Società, University of Udine, Udine, Italy; Scientific Institute, IRCCS Eugenio Medea, San Vito al Tagliamento, Pordenone, Italy; Claudiana - Landesfachhochschule für Gesundheitsberufe, Bolzano, Italy.
| | - Valentina Galetto
- Centro Puzzle, Torino, Italy; Center for Cognitive Science, Università degli Studi di Torino, Italy
| | - Karina Tatu
- Dipartimento di Psicologia, Università di Torino, Italy; Koelliker Hospital, Turin, Italy
| | | | - Giuliano Geminiani
- Center for Cognitive Science, Università degli Studi di Torino, Italy; Dipartimento di Psicologia, Università di Torino, Italy; Koelliker Hospital, Turin, Italy; Neuroscience Institute of Turin, Italy
| | - Katiuscia Sacco
- Center for Cognitive Science, Università degli Studi di Torino, Italy; Dipartimento di Psicologia, Università di Torino, Italy; Koelliker Hospital, Turin, Italy; Neuroscience Institute of Turin, Italy
| | - Marina Zettin
- Centro Puzzle, Torino, Italy; Center for Cognitive Science, Università degli Studi di Torino, Italy; Dipartimento di Psicologia, Università di Torino, Italy.
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Stevens MTR, Clarke DB, Stroink G, Beyea SD, D'Arcy RC. Improving fMRI reliability in presurgical mapping for brain tumours. J Neurol Neurosurg Psychiatry 2016; 87:267-74. [PMID: 25814491 DOI: 10.1136/jnnp-2015-310307] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/27/2015] [Indexed: 11/04/2022]
Abstract
PURPOSE Functional MRI (fMRI) is becoming increasingly integrated into clinical practice for presurgical mapping. Current efforts are focused on validating data quality, with reliability being a major factor. In this paper, we demonstrate the utility of a recently developed approach that uses receiver operating characteristic-reliability (ROC-r) to: (1) identify reliable versus unreliable data sets; (2) automatically select processing options to enhance data quality; and (3) automatically select individualised thresholds for activation maps. METHODS Presurgical fMRI was conducted in 16 patients undergoing surgical treatment for brain tumours. Within-session test-retest fMRI was conducted, and ROC-reliability of the patient group was compared to a previous healthy control cohort. Individually optimised preprocessing pipelines were determined to improve reliability. Spatial correspondence was assessed by comparing the fMRI results to intraoperative cortical stimulation mapping, in terms of the distance to the nearest active fMRI voxel. RESULTS The average ROC-r reliability for the patients was 0.58±0.03, as compared to 0.72±0.02 in healthy controls. For the patient group, this increased significantly to 0.65±0.02 by adopting optimised preprocessing pipelines. Co-localisation of the fMRI maps with cortical stimulation was significantly better for more reliable versus less reliable data sets (8.3±0.9 vs 29±3 mm, respectively). CONCLUSIONS We demonstrated ROC-r analysis for identifying reliable fMRI data sets, choosing optimal postprocessing pipelines, and selecting patient-specific thresholds. Data sets with higher reliability also showed closer spatial correspondence to cortical stimulation. ROC-r can thus identify poor fMRI data at time of scanning, allowing for repeat scans when necessary. ROC-r analysis provides optimised and automated fMRI processing for improved presurgical mapping.
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Affiliation(s)
- M Tynan R Stevens
- Department of Physics, Dalhousie University, Halifax, Nova Scotia, Canada Biomedical Translational Imaging Centre, IWK Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - David B Clarke
- Division of Neurosurgery, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada Division of Surgery, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Gerhard Stroink
- Department of Physics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steven D Beyea
- Department of Physics, Dalhousie University, Halifax, Nova Scotia, Canada Biomedical Translational Imaging Centre, IWK Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Ryan Cn D'Arcy
- Department of Computing Science, Simon Fraser University, Burnaby, British Columbia, Canada
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Bailey PD, Zacà D, Basha MM, Agarwal S, Gujar SK, Sair HI, Eng J, Pillai JJ. Presurgical fMRI and DTI for the Prediction of Perioperative Motor and Language Deficits in Primary or Metastatic Brain Lesions. J Neuroimaging 2015; 25:776-784. [DOI: 10.1111/jon.12273] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Paul D. Bailey
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine; Baltimore MD
| | - Domenico Zacà
- Center for Mind/Brain Sciences; University of Trento; Trento Italy
| | | | - Shruti Agarwal
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine; Baltimore MD
| | - Sachin K. Gujar
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine; Baltimore MD
| | - Haris I. Sair
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine; Baltimore MD
| | - John Eng
- Division of General and Diagnostic Radiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine; Baltimore MD
| | - Jay J. Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins Hospital & The Johns Hopkins University School of Medicine; Baltimore MD
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Abstract
Advanced MR imaging techniques have found extensive utility in the clinical practice of neuroradiology. A variety of these techniques are incorporated into imaging protocols for routine use, specific applications to particular disease entities, or as problem-solving tools on an ad hoc basis. This article summarizes and illustrates the spectrum of advanced MR imaging tools used clinically in the practice of neuroradiology.
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De Witte E, Satoer D, Robert E, Colle H, Verheyen S, Visch-Brink E, Mariën P. The Dutch Linguistic Intraoperative Protocol: a valid linguistic approach to awake brain surgery. BRAIN AND LANGUAGE 2015; 140:35-48. [PMID: 25526520 DOI: 10.1016/j.bandl.2014.10.011] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/03/2014] [Accepted: 10/25/2014] [Indexed: 05/10/2023]
Abstract
Intraoperative direct electrical stimulation (DES) is increasingly used in patients operated on for tumours in eloquent areas. Although a positive impact of DES on postoperative linguistic outcome is generally advocated, information about the neurolinguistic methods applied in awake surgery is scarce. We developed for the first time a standardised Dutch linguistic test battery (measuring phonology, semantics, syntax) to reliably identify the critical language zones in detail. A normative study was carried out in a control group of 250 native Dutch-speaking healthy adults. In addition, the clinical application of the Dutch Linguistic Intraoperative Protocol (DuLIP) was demonstrated by means of anatomo-functional models and five case studies. A set of DuLIP tests was selected for each patient depending on the tumour location and degree of linguistic impairment. DuLIP is a valid test battery for pre-, intraoperative and postoperative language testing and facilitates intraoperative mapping of eloquent language regions that are variably located.
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Affiliation(s)
- E De Witte
- Clinical and Experimental Neurolinguistics, Centre for Linguistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - D Satoer
- Department of Neurosurgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Department of Neurolinguistics, Groningen Center of Expertise for Language and Communication Disorders (GELC), University of Groningen, The Netherlands
| | - E Robert
- Department of Neurosurgery, AZ Sint-Lucas, Ghent, Belgium
| | - H Colle
- Department of Neurosurgery, AZ Sint-Lucas, Ghent, Belgium
| | - S Verheyen
- Department of Psychology, Catholic University Leuven, Belgium
| | - E Visch-Brink
- Department of Neurosurgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - P Mariën
- Clinical and Experimental Neurolinguistics, Centre for Linguistics, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurology and Memory Clinic, ZNA Middelheim, Antwerp, Belgium.
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Chang EF, Raygor KP, Berger MS. Contemporary model of language organization: an overview for neurosurgeons. J Neurosurg 2014; 122:250-61. [PMID: 25423277 DOI: 10.3171/2014.10.jns132647] [Citation(s) in RCA: 237] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Classic models of language organization posited that separate motor and sensory language foci existed in the inferior frontal gyrus (Broca's area) and superior temporal gyrus (Wernicke's area), respectively, and that connections between these sites (arcuate fasciculus) allowed for auditory-motor interaction. These theories have predominated for more than a century, but advances in neuroimaging and stimulation mapping have provided a more detailed description of the functional neuroanatomy of language. New insights have shaped modern network-based models of speech processing composed of parallel and interconnected streams involving both cortical and subcortical areas. Recent models emphasize processing in "dorsal" and "ventral" pathways, mediating phonological and semantic processing, respectively. Phonological processing occurs along a dorsal pathway, from the posterosuperior temporal to the inferior frontal cortices. On the other hand, semantic information is carried in a ventral pathway that runs from the temporal pole to the basal occipitotemporal cortex, with anterior connections. Functional MRI has poor positive predictive value in determining critical language sites and should only be used as an adjunct for preoperative planning. Cortical and subcortical mapping should be used to define functional resection boundaries in eloquent areas and remains the clinical gold standard. In tracing the historical advancements in our understanding of speech processing, the authors hope to not only provide practicing neurosurgeons with additional information that will aid in surgical planning and prevent postoperative morbidity, but also underscore the fact that neurosurgeons are in a unique position to further advance our understanding of the anatomy and functional organization of language.
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Affiliation(s)
- Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, California
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Yao C, Liu Y, Yao J, Zhuang D, Wu J, Qin Z, Mao Y, Zhou L. Augment low-field intra-operative MRI with preoperative MRI using a hybrid non-rigid registration method. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 117:114-124. [PMID: 25178268 DOI: 10.1016/j.cmpb.2014.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/25/2014] [Accepted: 07/30/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Preoperatively acquired diffusion tensor image (DTI) and blood oxygen level dependent (BOLD) have been proved to be effective in providing more anatomical and functional information; however, the brain deformation induced by brain shift and tumor resection severely impairs the correspondence between the image space and the patient space in image-guided neurosurgery. METHOD To address the brain deformation, we developed a hybrid non-rigid registration method to register high-field preoperative MRI with low-field intra-operative MRI in order to recover the deformation induced by brain shift and tumor resection. The registered DTI and BOLD are fused with low-field intra-operative MRI for image-guided neurosurgery. RESULTS The proposed hybrid registration method was evaluated by comparing the landmarks predicted by the hybrid registration method with the landmarks identified in the low-field intra-operative MRI for 10 patients. The prediction error of the hybrid method is 1.92±0.54 mm, and the compensation accuracy is 74.3±5.0%. Compared to the landmarks far from the resection region, those near the resection region demonstrated a higher compensation accuracy (P-value=.003) although these landmarks had larger initial displacements. CONCLUSIONS The proposed hybrid registration method is able to bring preoperatively acquired BOLD and DTI into the operating room and compensate for the deformation to augment low-field intra-operative MRI with rich anatomical and functional information.
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Affiliation(s)
- Chengjun Yao
- Glioma Surgery Division, Neurological Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, PR China
| | - Yixun Liu
- Radiology and Imaging Sciences, National Institutes of Health, PR China
| | - Jianhua Yao
- Radiology and Imaging Sciences, National Institutes of Health, PR China
| | - Dongxiao Zhuang
- Glioma Surgery Division, Neurological Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, PR China
| | - Jinsong Wu
- Glioma Surgery Division, Neurological Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, PR China.
| | - Zhiyong Qin
- Glioma Surgery Division, Neurological Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, PR China
| | - Ying Mao
- Glioma Surgery Division, Neurological Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, PR China
| | - Liangfu Zhou
- Glioma Surgery Division, Neurological Surgery Department, Huashan Hospital, Shanghai Medical College, Fudan University, PR China.
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Spena G, Panciani PP, Fontanella MM. Resection of supratentorial gliomas: the need to merge microsurgical technical cornerstones with modern functional mapping concepts. An overview. Neurosurg Rev 2014; 38:59-70; discussion 70. [PMID: 25328001 DOI: 10.1007/s10143-014-0578-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/22/2014] [Accepted: 06/22/2014] [Indexed: 01/09/2023]
Abstract
Although surgery is not curative for the majority of intracranial gliomas, radical resection has been demonstrated to influence survival and delay tumor progression. Because gliomas are very frequently located in eloquent or more generally critical areas, surgeons must always balance the maximizing resection with the need to preserve neurological function. In this overview, we tried to summarize the recent literature and our personal experience about (1) the benefits and limits of using preoperative anatomical and functional neuroimaging (anatomical MRI, DTI fiber tracking, and functional MRI), (2) the issues to consider in planning the surgical strategy, (3) the need to thoroughly understand microsurgical techniques that enable a maximal resection (subpial dissection, vascular manipulation, etc.), (4) the importance of individualizing surgical strategy especially in patients with gliomas in eloquent areas (the role of neuropsychological evaluation in redefining eloquent and non-eloquent areas), and (5) how to use intraoperative mapping techniques and understand why and when to use them. Through this paper, the reader should become more familiar with a comprehensive panel of techniques and methodologies but more importantly become aware that these recent technical advances facilitate a conceptual change from classical surgical paradigms toward a more patient-specific approach.
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Affiliation(s)
- Giannantonio Spena
- Neurosurgery Department, Spedali Civili and University of Brescia, Brescia, Italy,
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Piangerelli M, Ciavarro M, Paris A, Marchetti S, Cristiani P, Puttilli C, Torres N, Benabid AL, Romanelli P. A fully integrated wireless system for intracranial direct cortical stimulation, real-time electrocorticography data transmission, and smart cage for wireless battery recharge. Front Neurol 2014; 5:156. [PMID: 25202300 PMCID: PMC4142710 DOI: 10.3389/fneur.2014.00156] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 07/31/2014] [Indexed: 11/18/2022] Open
Abstract
Wireless transmission of cortical signals is an essential step to improve the safety of epilepsy procedures requiring seizure focus localization and to provide chronic recording of brain activity for Brain Computer Interface (BCI) applications. Our group developed a fully implantable and externally rechargeable device, able to provide wireless electrocorticographic (ECoG) recording and cortical stimulation (CS). The first prototype of a wireless multi-channel very low power ECoG system was custom-designed to be implanted on non-human primates. The device, named ECOGIW-16E, is housed in a compact hermetically sealed Polyether ether ketone (PEEK) enclosure, allowing seamless battery recharge. ECOGIW-16E is recharged in a wireless fashion using a special cage designed to facilitate the recharge process in monkeys and developed in accordance with guidelines for accommodation of animals by Council of Europe (ETS123). The inductively recharging cage is made up of nylon and provides a thoroughly novel experimental setting on freely moving animals. The combination of wireless cable-free ECoG and external seamless battery recharge solves the problems and shortcomings caused by the presence of cables leaving the skull, providing a safer and easier way to monitor patients and to perform ECoG recording on primates. Data transmission exploits the newly available Medical Implant Communication Service band (MICS): 402–405 MHz. ECOGIW-16E was implanted over the left sensorimotor cortex of a macaca fascicularis to assess the feasibility of wireless ECoG monitoring and brain mapping through CS. With this device, we were able to record the everyday life ECoG signal from a monkey and to deliver focal brain stimulation with movement elicitation.
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Affiliation(s)
- Marco Piangerelli
- Computer Science Division, School of Science and Technology, University of Camerino , Camerino , Italy
| | | | | | | | | | | | - Napoleon Torres
- Clinatec, Laboratoire d' Électronique des Technologies de l'Information (LETI), Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) , Grenoble , France
| | - Alim Louis Benabid
- Clinatec, Laboratoire d' Électronique des Technologies de l'Information (LETI), Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) , Grenoble , France
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Brainstem cavernoma surgery with the support of pre- and postoperative diffusion tensor imaging: initial experiences and clinical course of 23 patients. Neurosurg Rev 2014; 37:481-91; discussion 492. [DOI: 10.1007/s10143-014-0550-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 08/20/2013] [Accepted: 01/19/2014] [Indexed: 10/25/2022]
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Loring DW, Gaillard WD, Bookheimer SY, Meador KJ, Ojemann JG. Cortical cartography reveals political and physical maps. Epilepsia 2014; 55:633-637. [PMID: 24815217 PMCID: PMC4197796 DOI: 10.1111/epi.12553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2014] [Indexed: 11/28/2022]
Abstract
Advances in functional imaging have provided noninvasive techniques to probe brain organization of multiple constructs including language and memory. Because of high overall rates of agreements with older techniques, including Wada testing and cortical stimulation mapping (CSM), some have proposed that those approaches should be largely abandoned because of their invasiveness, and replaced with noninvasive functional imaging methods. High overall agreement, however, is based largely on concordant language lateralization in series dominated by cases of typical cerebral dominance. Advocating a universal switch from Wada testing and cortical stimulation mapping to functional magnetic resonance imaging (fMRI) or magnetoencephalography (MEG) ignores the differences in specific expertise across epilepsy centers, many of which often have greater skill with one approach rather than the other, and that Wada, CSM, fMRI, and MEG protocols vary across institutions resulting in different outcomes and reliability. Specific patient characteristics also affect whether Wada or CSM might influence surgical management, making it difficult to accept broad recommendations against currently useful clinical tools. Although the development of noninvasive techniques has diminished the frequency of more invasive approaches, advocating their use to replace Wada testing and CSM across all epilepsy surgery programs without consideration of the different skills, protocols, and expertise at any given center site is ill-advised.
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Affiliation(s)
- David W. Loring
- Departments of Neurology and Pediatrics, Emory University, Atlanta, GA
| | | | | | - Kimford J. Meador
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA
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Motomura K, Fujii M, Maesawa S, Kuramitsu S, Natsume A, Wakabayashi T. Association of dorsal inferior frontooccipital fasciculus fibers in the deep parietal lobe with both reading and writing processes: a brain mapping study. J Neurosurg 2014; 121:142-8. [PMID: 24655122 DOI: 10.3171/2014.2.jns131234] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Alexia and agraphia are disorders common to the left inferior parietal lobule, including the angular and supramarginal gyri. However, it is still unclear how these cortical regions interact with other cortical sites and what the most important white matter tracts are in relation to reading and writing processes. Here, the authors present the case of a patient who underwent an awake craniotomy for a left inferior parietal lobule glioma using direct cortical and subcortical electrostimulation. The use of subcortical stimulation allowed identification of the specific white matter tracts associated with reading and writing. These tracts were found as portions of the dorsal inferior frontooccipital fasciculus (IFOF) fibers in the deep parietal lobe that are responsible for connecting the frontal lobe to the superior parietal lobule. These findings are consistent with previous diffusion tensor imaging tractography and functional MRI studies, which suggest that the IFOF may play a role in the reading and writing processes. This is the first report of transient alexia and agraphia elicited through intraoperative direct subcortical electrostimulation, and the findings support the crucial role of the IFOF in reading and writing.
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67
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Spena G, D’Agata F, Panciani PP, Buglione di Monale M, Fontanella MM. Supratentorial gliomas in eloquent areas: which parameters can predict functional outcome and extent of resection? PLoS One 2013; 8:e80916. [PMID: 24339890 PMCID: PMC3855229 DOI: 10.1371/journal.pone.0080916] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/07/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To date, few parameters have been found that can aid in patient selection and surgical strategy for eloquent area gliomas. AIMS The aim of the study was to analyze preoperative and intraoperative factors that can predict functional outcome and extent of resection in eloquent area tumors. PATIENTS AND METHODS A retrospective analysis was conducted on 60 patients harboring supratentorial gliomas in eloquent areas undergoing awake surgery. The analysis considered clinical, neuroradiologic (morphologic), intraoperative, and postoperative factors. End-points were extent of resection (EOR) as well as functional short- and long-term outcome. Postoperatively, MRI objectively established the EOR. χ(2) analyses were used to evaluate parameters that could be predictive. Multivariate logistic regression analyses were used to evaluate the best combination to predict binary positive outcomes. RESULTS In 90% of the cases, subcortical stimulation was positive in the margins of the surgical cavity. Postoperatively, 51% of the patients deteriorated but 90% of the patients regained their preoperative neurological score. Factors negatively affecting EOR were volume, degree of subcortical infiltration, and presence of paresis (P<0.01). Sharp margins and cystic components were more amenable to gross total resection (P<0.01). Contrast enhancement (P<0.02), higher grade (P<0.01), paresis (P<0.01), and residual tumor in the cortex (P<0.02) negatively affected long-term functional outcomes, whereas postoperative deterioration could not be predicted for any factor other than paresis. Subcortical stimulation did not correlate with deterioration, both postoperatively (P<0.08) and at follow-up (P<0.042). CONCLUSIONS Biological and morphological factors such as type of margins, volume, preoperative neurological status, cystic components, histology and the type of infiltration into the white matter must be considered when planning intraoperative mapping.
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Affiliation(s)
- Giannantonio Spena
- Neurosurgery Department, Spedali Civili and University of Brescia, Brescia, Italy
| | - Federico D’Agata
- Psychology Department and Neuroscience Department of the University of Turin, Turin, Italy
| | - Pier Paolo Panciani
- Neurosurgery Department, Spedali Civili and University of Brescia, Brescia, Italy
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Kollndorfer K, Furtner J, Krajnik J, Prayer D, Schöpf V. Attention shifts the language network reflecting paradigm presentation. Front Hum Neurosci 2013; 7:809. [PMID: 24324429 PMCID: PMC3838991 DOI: 10.3389/fnhum.2013.00809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 11/07/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Functional magnetic resonance imaging (fMRI) is a reliable and non-invasive method with which to localize language function in pre-surgical planning. In clinical practice, visual stimulus presentation is often difficult or impossible, due to the patient's restricted language or attention abilities. Therefore, our aim was to investigate modality-specific differences in visual and auditory stimulus presentation. METHODS Ten healthy subjects participated in an fMRI study comprising two experiments with visual and auditory stimulus presentation. In both experiments, two language paradigms (one for language comprehension and one for language production) used in clinical practice were investigated. In addition to standard data analysis by the means of the general linear model (GLM), independent component analysis (ICA) was performed to achieve more detailed information on language processing networks. RESULTS GLM analysis revealed modality-specific brain activation for both language paradigms for the contrast visual > auditory in the area of the intraparietal sulcus and the hippocampus, two areas related to attention and working memory. Using group ICA, a language network was detected for both paradigms independent of stimulus presentation modality. The investigation of language lateralization revealed no significant variations. Visually presented stimuli further activated an attention-shift network, which could not be identified for the auditory presented language. CONCLUSION The results of this study indicate that the visually presented language stimuli additionally activate an attention-shift network. These findings will provide important information for pre-surgical planning in order to preserve reading abilities after brain surgery, significantly improving surgical outcomes. Our findings suggest that the presentation modality for language paradigms should be adapted on behalf of individual indication.
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Affiliation(s)
- Kathrin Kollndorfer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna Vienna, Austria
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Shinoura N, Midorikawa A, Yamada R, Hana T, Saito A, Hiromitsu K, Itoi C, Saito S, Yagi K. Awake craniotomy for brain lesions within and near the primary motor area: A retrospective analysis of factors associated with worsened paresis in 102 consecutive patients. Surg Neurol Int 2013; 4:149. [PMID: 24381792 PMCID: PMC3872643 DOI: 10.4103/2152-7806.122003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/19/2013] [Indexed: 11/04/2022] Open
Abstract
Background: We analyzed factors associated with worsened paresis in a large series of patients with brain lesions located within or near the primary motor area (M1) to establish protocols for safe, awake craniotomy of eloquent lesions. Methods: We studied patients with brain lesions involving M1, the premotor area (PMA) and the primary sensory area (S1), who underwent awake craniotomy (n = 102). In addition to evaluating paresis before, during, and one month after surgery, the following parameters were analyzed: Intraoperative complications; success or failure of awake surgery; tumor type (A or B), tumor location, tumor histology, tumor size, and completeness of resection. Results: Worsened paresis at one month of follow-up was significantly associated with failure of awake surgery, intraoperative complications and worsened paresis immediately after surgery, which in turn was significantly associated with intraoperative worsening of paresis. Intraoperative worsening of paresis was significantly related to preoperative paresis, type A tumor (motor tract running in close proximity to and compressed by the tumor), tumor location within or including M1 and partial removal (PR) of the tumor. Conclusions: Successful awake surgery and prevention of deterioration of paresis immediately after surgery without intraoperative complications may help prevent worsening of paresis at one month. Factors associated with intraoperative worsening of paresis were preoperative motor deficit, type A and tumor location in M1, possibly leading to PR of the tumor.
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Affiliation(s)
- Nobusada Shinoura
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Akira Midorikawa
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Ryoji Yamada
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Taijun Hana
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Akira Saito
- Department of Neurosurgery, Komagome Metropolitan Hospital, 3-18-22 Hon-komagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Kentaro Hiromitsu
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Chisato Itoi
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Syoko Saito
- Department of Psychology, Chuo University of Literature, 742-1 Higashi-nakano, Hachioji City, Tokyo 192-0393, Japan
| | - Kazuo Yagi
- Department of Radiologic Technology, Tokyo Metropolitan University of Health Sciences, 7-2-10 Higashiogu, Arakawa-ku, Tokyo 116-8553, Japan
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Tate MC, Guo L, McEvoy J, Chang EF. Safety and efficacy of motor mapping utilizing short pulse train direct cortical stimulation. Stereotact Funct Neurosurg 2013; 91:379-85. [PMID: 24108152 DOI: 10.1159/000350020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 01/20/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS A major goal of intracranial surgery is to maximize resection while minimizing neurological morbidity, particularly motor dysfunction. Direct cortical stimulation (DCS) is a common intraoperative adjunct used to identify functional motor cortex. In this study, we report on the safety/efficacy of short pulse train DCS (direct cortical stimulation motor-evoked potential, dcMEP) for motor mapping and monitoring during intracranial surgery. METHODS A retrospective analysis of 29 patients undergoing elective craniotomy for lesions near the motor cortex was performed. dcMEP mapping (40-120 V, 500-1,000 Hz, 5-9 pulses/s, 1- to 3-ms interstimulus interval, monopolar, 50-μs pulse width) was performed either alone (n = 29) or in addition to standard DCS (n = 6). Outcome measures were positive MEPs and the presence of seizures during stimulation. dcMEP-based continuous corticospinal tract (CST) monitoring was also performed. Changes in stimulation threshold and new postoperative neurological deficits were recorded. RESULTS dcMEP mapping success was 96% and was not affected by preoperative motor status. Intraoperative seizure rates for dcMEP were 3% and were not related to preoperative seizure status. CST monitoring success rate was 96%, and changes in stimulation threshold were predictive of new permanent motor deficits. CONCLUSIONS dcMEP is an effective method for mapping motor function and may prove useful for continuous CST monitoring.
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Affiliation(s)
- Matthew C Tate
- Department of Neurological Surgery, University of California, San Francisco, Calif., USA
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Côté MA, Girard G, Boré A, Garyfallidis E, Houde JC, Descoteaux M. Tractometer: Towards validation of tractography pipelines. Med Image Anal 2013; 17:844-57. [PMID: 23706753 DOI: 10.1016/j.media.2013.03.009] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/04/2013] [Accepted: 03/28/2013] [Indexed: 12/13/2022]
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Purely subcortical tumors in eloquent areas: Awake surgery and cortical and subcortical electrical stimulation (CSES) ensure safe and effective surgery. Clin Neurol Neurosurg 2013; 115:1595-601. [DOI: 10.1016/j.clineuro.2013.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 11/17/2022]
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Kumar VA, Hamilton J, Hayman LA, Kumar AJ, Rao G, Weinberg JS, Sawaya R, Prabhu SS. Deformable Anatomic Templates Improve Analysis of Gliomas With Minimal Mass Effect in Eloquent Areas. Neurosurgery 2013; 73:534-42. [DOI: 10.1227/01.neu.0000431479.87160.e2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Despite improvements in advanced magnetic resonance imaging and intraoperative mapping, cases remain in which it is difficult to determine whether viable eloquent structures are involved by a glioma. A novel software program, deformable anatomic templates (DAT), rapidly embeds the normal location of eloquent cortex and functional tracts in the magnetic resonance images of glioma-bearing brain.
OBJECTIVE:
To investigate the feasibility of the DAT technique in patients with gliomas related to eloquent brain.
METHODS:
Forty cases of gliomas (grade II-IV) with minimal mass effect were referred for a prospective preoperative and postoperative DAT analysis. The DAT results were compared with the patient's functional magnetic resonance imaging, diffusion tensor imaging, operative stimulation, and new postoperative clinical deficits.
RESULTS:
Fifteen of the 40 glioma patients had overlap between tumor and eloquent structures. Immediate postoperative neurological deficits were seen in 9 cases in which the DAT showed the eloquent area both within the tumor and within or at the edge of the resection cavity. In 6 cases with no deficits, DAT placed the eloquent area in the tumor but outside the resection cavity.
CONCLUSION:
This is proof of concept that DAT can improve the analysis of diffuse gliomas of any grade by efficiently alerting the surgeon to the possibility of eloquent area invasion. The technique is especially helpful in diffuse glioma because these tumors tend to infiltrate rather than displace eloquent structures. DAT is limited by tract displacement in gliomas that produces moderate to severe mass effect.
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Affiliation(s)
| | | | | | | | - Ganesh Rao
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S. Weinberg
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Raymond Sawaya
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S. Prabhu
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas
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Rodionov R, Vollmar C, Nowell M, Miserocchi A, Wehner T, Micallef C, Zombori G, Ourselin S, Diehl B, McEvoy AW, Duncan JS. Feasibility of multimodal 3D neuroimaging to guide implantation of intracranial EEG electrodes. Epilepsy Res 2013; 107:91-100. [PMID: 24029810 PMCID: PMC3830177 DOI: 10.1016/j.eplepsyres.2013.08.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/29/2013] [Accepted: 08/03/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since intracranial electrode implantation has limited spatial sampling and carries significant risk, placement has to be effective and efficient. Structural and functional imaging of several different modalities contributes to localising the seizure onset zone (SoZ) and eloquent cortex. There is a need to summarise and present this information throughout the pre/intra/post-surgical course. METHODS We developed and implemented a multimodal 3D neuroimaging (M3N) pipeline to guide implantation of intracranial EEG (icEEG) electrodes. We report the implementation of the pipeline for operative planning and a description of its use in clinical decision-making. RESULTS The results of intraoperative application of the M3N pipeline demonstrated clinical benefits in all 15 implantation surgeries assessed. The M3N software was used to simulate placement of intracranial electrodes in 2 cases. The key benefits of using the M3N pipeline are illustrated in 3 representative case reports. CONCLUSION We have demonstrated feasibility of the developed intraoperative M3N pipeline which serves as a prototype for clinical implementation. Further validity studies with larger sample groups are required to determine the utility of M3N in routine surgical practice.
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Affiliation(s)
- Roman Rodionov
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK; Epilepsy Society, MRI Unit, Chalfont St Peter, UK.
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75
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Desmurget M, Song Z, Mottolese C, Sirigu A. Re-establishing the merits of electrical brain stimulation. Trends Cogn Sci 2013; 17:442-9. [PMID: 23932195 DOI: 10.1016/j.tics.2013.07.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 07/05/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
Abstract
During the past decades, direct electrical stimulation (DES) has been a key method not only in determining the organization of brain networks mediating movement, language, and cognition but also in establishing many central concepts of modern neuroscience, such as the electrical nature of neural transmission, the localization of brain functions, and the homuncular arrangement of sensorimotor areas. However, recent criticisms have questioned the utility of DES and argued that data collected with this technique may be flawed and unreliable. As with every other neuroscientific method, DES does have limitations. However, existing evidence argues strongly for its validity and usefulness by demonstrating that DES produces highly specific outcomes at well-defined anatomical sites and significantly minimizes postoperative deficits in brain-damaged patients.
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76
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Abd-El-Barr MM, Saleh E, Huang RY, Golby AJ. Effect of disease and recovery on functional anatomy in brain tumor patients: insights from functional MRI and diffusion tensor imaging. ACTA ACUST UNITED AC 2013; 5:333-346. [PMID: 24660024 DOI: 10.2217/iim.13.40] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patients with brain tumors provide a unique opportunity to understand functional brain plasticity. Using advanced imaging techniques, such as functional MRI and diffusion tensor imaging, we have gained tremendous knowledge of brain tumor behavior, transformation, infiltration and destruction of nearby structures. Using these advanced techniques as an adjunct with more proven techniques, such as direct cortical stimulation, intraoperative navigation and advanced microsurgical techniques, we now are able to better formulate safer resection trajectories, perform larger resections at reduced risk and better counsel patients and their families about possible complications. Brain mapping in patients with brain tumors and other lesions has shown us that the old idea of fixed function of the adult cerebral cortex is not entirely true. Improving care for patients with brain lesions in the future will depend on better understanding of the functional organization and plasticity of the adult brain. Advanced noninvasive brain imaging will undoubtedly play a role in advancing this understanding.
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Affiliation(s)
- Muhammad M Abd-El-Barr
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Emam Saleh
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA ; Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Awake language mapping and 3-Tesla intraoperative MRI-guided volumetric resection for gliomas in language areas. J Clin Neurosci 2013; 20:1280-7. [PMID: 23850046 DOI: 10.1016/j.jocn.2012.10.042] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 10/04/2012] [Accepted: 10/07/2012] [Indexed: 11/23/2022]
Abstract
The use of both awake surgery and intraoperative MRI (iMRI) has been reported to optimize the maximal safe resection of gliomas. However, there has been little research into combining these two demanding procedures. We report our unique experience with, and methodology of, awake surgery in a movable iMRI system, and we quantitatively evaluate the contribution of the combination on the extent of resection (EOR) and functional outcome of patients with gliomas involving language areas. From March 2011 to November 2011, 30 consecutive patients who underwent awake surgery with iMRI guidance were prospectively investigated. The EOR was assessed by volumetric analysis. Language assessment was conducted before surgery and 1 week, 1 month, 3 months and 6 months after surgery using the Aphasia Battery of Chinese. Awake language mapping integrated with 3.0 Tesla iMRI was safely performed for all patients. An additional resection was conducted in 11 of 30 patients (36.7%) after iMRI. The median EOR significantly increased from 92.5% (range, 75.1-97.0%) to 100% (range, 92.6-100%) as a result of iMRI (p<0.01). Gross total resection was achieved in 18 patients (60.0%), and in seven of those patients (23.3%), the gross total resection could be attributed to iMRI. A total of 12 patients (40.0%) suffered from transient language deficits; however, only one (3.3%) patient developed a permanent deficit. This study demonstrates the potential utility of combining awake craniotomy with iMRI; it is safe and reliable to perform awake surgery using a movable iMRI.
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78
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Yao X, Wang M, Chen X, Nie S, Li Z, Xu X, Zhang X, Song Z. Diffusion tensor imaging fiber tracking with reliable tracking orientation and flexible step size. Neural Regen Res 2013; 8:1481-90. [PMID: 25206444 PMCID: PMC4107807 DOI: 10.3969/j.issn.1673-5374.2013.16.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 04/20/2013] [Indexed: 11/18/2022] Open
Abstract
We propose a method of reliable tracking orientation and flexible step size fiber tracking. A new directional strategy was defined to select one optimal tracking orientation from each directional set, which was based on the single-tensor model and the two-tensor model. The directional set of planar voxels contained three tracking directions: two from the two-tensor model and one from the single-tensor model. The directional set of linear voxels contained only one principal vector. In addition, a flexible step size, rather than fixable step sizes, was implemented to improve the accuracy of fiber tracking. We used two sets of human data to assess the performance of our method; one was from a healthy volunteer and the other from a patient with low-grade glioma. Results verified that our method was superior to the single-tensor Fiber Assignment by Continuous Tracking and the two-tensor eXtended Streamline Tractography for showing detailed images of fiber bundles.
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Affiliation(s)
- Xufeng Yao
- Shanghai Medical Instrument College, School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200091, China ; Digital Medical Research Center, Shanghai Medical School, Fudan University/The Key Laboratory of MICCAI of Shanghai, Shanghai 200032, China
| | - Manning Wang
- Digital Medical Research Center, Shanghai Medical School, Fudan University/The Key Laboratory of MICCAI of Shanghai, Shanghai 200032, China
| | - Xinrong Chen
- Digital Medical Research Center, Shanghai Medical School, Fudan University/The Key Laboratory of MICCAI of Shanghai, Shanghai 200032, China
| | - Shengdong Nie
- Shanghai Medical Instrument College, School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200091, China
| | - Zhexu Li
- Shanghai Medical Instrument College, School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200091, China
| | - Xiaoping Xu
- Shanghai Medical Instrument College, School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200091, China
| | - Xuelong Zhang
- Shanghai Medical Instrument College, School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai 200091, China
| | - Zhijian Song
- Digital Medical Research Center, Shanghai Medical School, Fudan University/The Key Laboratory of MICCAI of Shanghai, Shanghai 200032, China
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Zhu FP, Wu JS, Song YY, Yao CJ, Zhuang DX, Xu G, Tang WJ, Qin ZY, Mao Y, Zhou LF. Clinical application of motor pathway mapping using diffusion tensor imaging tractography and intraoperative direct subcortical stimulation in cerebral glioma surgery: a prospective cohort study. Neurosurgery 2013; 71:1170-83; discussion 1183-4. [PMID: 22986591 DOI: 10.1227/neu.0b013e318271bc61] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Glioma surgery in eloquent areas remains a challenge because of the risk of postoperative motor deficits. OBJECTIVE To prospectively evaluate the efficiency of using a combination of diffusion tensor imaging (DTI) tractography functional neuronavigation and direct subcortical stimulation (DsCS) to yield a maximally safe resection of cerebral glioma in eloquent areas. METHODS A prospective cohort study was conducted in 58 subjects with an initial diagnosis of primary cerebral glioma within or adjacent to the pyramidal tract (PT). The white matter beneath the resection cavity was stimulated along the PT, which was visualized with DTI tractography. The intercept between the PT border and DsCS site was measured. The sensitivity and specificity of DTI tractography for PT mapping were evaluated. The efficiency of the combined use of both techniques on motor function preservation was assessed. RESULTS Postoperative analysis showed gross total resection in 40 patients (69.0%). Seventeen patients (29.3%) experienced postoperative worsening; 1-month motor deficit was observed in 6 subjects (10.3%). DsCS verified a high concordance rate with DTI tractography for PT mapping. The sensitivity and specificity of DTI were 92.6% and 93.2%, respectively. The intercepts between positive DsCS sites and imaged PTs were 2.0 to 14.7 mm (5.2 ± 2.2 mm). The 6-month Karnofsky performance scale scores in 50 postoperative subjects were significantly increased compared with their preoperative scores. CONCLUSION DTI tractography is effective but not completely reliable in delineating the descending motor pathways. Integration of DTI and DsCS favors patient-specific surgery for cerebral glioma in eloquent areas.
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Affiliation(s)
- Feng-Ping Zhu
- Shanghai Medical College, Fudan University, Shanghai, China
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The neurolinguistic approach to awake surgery reviewed. Clin Neurol Neurosurg 2013; 115:127-45. [DOI: 10.1016/j.clineuro.2012.09.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 08/06/2012] [Accepted: 09/07/2012] [Indexed: 10/27/2022]
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81
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Dimou S, Battisti RA, Hermens DF, Lagopoulos J. A systematic review of functional magnetic resonance imaging and diffusion tensor imaging modalities used in presurgical planning of brain tumour resection. Neurosurg Rev 2012. [PMID: 23187966 DOI: 10.1007/s10143-012-0436-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Historically, brain tumour resection has relied upon standardised anatomical atlases and classical mapping techniques for successful resection. While these have provided adequate results in the past, the emergence of new technologies has heralded a wave of less invasive, patient-specific techniques for the mapping of brain function. Functional magnetic resonance imaging (fMRI) and, more recently, diffusion tensor imaging (DTI) are two such techniques. While fMRI is able to highlight localisation of function within the cortex, DTI represents the only technique able to elucidate white matter structures in vivo. Used in conjunction, both of these techniques provide important presurgical information for thorough preoperative planning, as well as intraoperatively via integration into frameless stereotactic neuronavigational systems. Together, these techniques show great promise for improved neurosurgical outcomes. While further research is required for more widespread clinical validity and acceptance, results from the literature provide a clear road map for future research and development to cement these techniques into the clinical setup of neurosurgical departments globally.
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Affiliation(s)
- S Dimou
- The Brain and Mind Research Institute, The University of Sydney, 94 Mallet Street, Camperdown, NSW, Australia
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82
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Kuhnt D, Bauer MHA, Becker A, Merhof D, Zolal A, Richter M, Grummich P, Ganslandt O, Buchfelder M, Nimsky C. Intraoperative visualization of fiber tracking based reconstruction of language pathways in glioma surgery. Neurosurgery 2012; 70:911-9; discussion 919-20. [PMID: 21946508 DOI: 10.1227/neu.0b013e318237a807] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND For neuroepithelial tumors, the surgical goal is maximum resection with preservation of neurological function. This is contributed to by intraoperative magnetic resonance imaging (iMRI) combined with multimodal navigation. OBJECTIVE We evaluated the contribution of diffusion tensor imaging (DTI)-based fiber tracking of language pathways with 2 different algorithms (tensor deflection, connectivity analysis [CA]) integrated in the navigation on the surgical outcome. METHODS We evaluated 32 patients with neuroepithelial tumors who underwent surgery with DTI-based fiber tracking of language pathways integrated in neuronavigation. The tensor deflection algorithm was routinely used and its results intraoperatively displayed in all cases. The CA algorithm was furthermore evaluated in 23 cases. Volumetric assessment was performed in pre- and intraoperative MR images. To evaluate the benefit of fiber tractography, language deficits were evaluated pre- and postoperatively and compared with the volumetric analysis. RESULTS Final gross-total resection was performed in 40.6% of patients. Absolute tumor volume was reduced from 55.33 ± 63.77 cm(3) to 20.61 ± 21.67 cm(3) in first iMRI resection control, to finally 11.56 ± 21.92 cm(3) (P < .01). Fiber tracking of the 2 algorithms showed a deviation of the displayed 3D objects by <5 mm. In long-term follow-up only 1 patient (3.1%) had a persistent language deficit. CONCLUSION Intraoperative visualization of language-related cortical areas and the connecting pathways with DTI-based fiber tracking can be successfully performed and integrated in the navigation system. In a setting of intraoperative high-field MRI this contributes to maximum tumor resection with low postoperative morbidity.
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Affiliation(s)
- Daniela Kuhnt
- Department of Neurosurgery, University of Marburg, Marburg, Germany.
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83
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Kapsalakis IZ, Kapsalaki EZ, Gotsis ED, Verganelakis D, Toulas P, Hadjigeorgiou G, Chung I, Fezoulidis I, Papadimitriou A, Robinson JS, Lee GP, Fountas KN. Preoperative evaluation with FMRI of patients with intracranial gliomas. Radiol Res Pract 2012; 2012:727810. [PMID: 22848821 PMCID: PMC3403517 DOI: 10.1155/2012/727810] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 05/01/2012] [Accepted: 05/07/2012] [Indexed: 01/13/2023] Open
Abstract
Introduction. Aggressive surgical resection constitutes the optimal treatment for intracranial gliomas. However, the proximity of a tumor to eloquent areas requires exact knowledge of its anatomic relationships to functional cortex. The purpose of our study was to evaluate fMRI's accuracy by comparing it to intraoperative cortical stimulation (DCS) mapping. Material and Methods. Eighty-seven patients, with presumed glioma diagnosis, underwent preoperative fMRI and intraoperative DCS for cortical mapping during tumor resection. Findings of fMRI and DCS were considered concordant if the identified cortical centers were less than 5 mm apart. Pre and postoperative Karnofsky Performance Scale and Spitzer scores were recorded. A postoperative MRI was obtained for assessing the extent of resection. Results. The areas of interest were identified by fMRI and DCS in all participants. The concordance between fMRI and DCS was 91.9% regarding sensory-motor cortex, 100% for visual cortex, and 85.4% for language. Data analysis showed that patients with better functional condition demonstrated higher concordance rates, while there also was a weak association between tumor grade and concordance rate. The mean extent of tumor resection was 96.7%. Conclusions. Functional MRI is a highly accurate preoperative methodology for sensory-motor mapping. However, in language mapping, DCS remains necessary for accurate localization.
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Affiliation(s)
- Ioannis Z. Kapsalakis
- Department of Neurology, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
| | - Eftychia Z. Kapsalaki
- Department of Diagnostic Radiology, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
| | - Efstathios D. Gotsis
- Department of MR Imaging, Advanced Diagnostic and Research Institute “Euromedica-Encephalos”, 15233 Athens, Greece
| | - Dimitrios Verganelakis
- Department of MR Imaging, Advanced Diagnostic and Research Institute “Euromedica-Encephalos”, 15233 Athens, Greece
| | - Panagiotis Toulas
- Department of MR Imaging, Advanced Diagnostic and Research Institute “Euromedica-Encephalos”, 15233 Athens, Greece
| | - Georgios Hadjigeorgiou
- Department of Neurology, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
| | - Indug Chung
- Departments of Neurosurgery and Intraoperative Electrophysiology, Medical Center of Central Georgia, School of Medicine, Mercer University, Macon, GA 31201, USA
| | - Ioannis Fezoulidis
- Department of Diagnostic Radiology, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
| | - Alexandros Papadimitriou
- Department of Neurology, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
| | - Joe Sam Robinson
- Departments of Neurosurgery and Intraoperative Electrophysiology, Medical Center of Central Georgia, School of Medicine, Mercer University, Macon, GA 31201, USA
| | - Gregory P. Lee
- Department of Neurology, Medical College of Georgia, Augusta, GA 30912, USA
| | - Kostas N. Fountas
- Department of Neurosurgery, School of Medicine, University Hospital of Larisa, University of Thessaly, 41110 Larisa, Greece
- Institute of Biomedical Research and Technology (BIOMED), Center for Research and Technology-Thessaly (CERETETH), 38500 Larissa, Greece
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84
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Deformable anatomic templates embed knowledge into brain images: part 2. Validation using functional magnetic resonance imaging of the motor hand. J Comput Assist Tomogr 2012; 36:280-4. [PMID: 22446375 DOI: 10.1097/rct.0b013e318245c21b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study evaluated the concordance between the Deformable Anatomic Template (DAT)-identified origin of motor hand fibers and localization of the motor cortex of the hand by functional magnetic resonance imaging (fMRI). METHODS Preoperative fMRI during hand motor tasks was performed on 36 hemispheres in 26 patients with gliomas in or near eloquent areas. Reformatted volume-rendered surface images were labeled with the DAT's hand motor fibers and fMRI data. Five reviewers assessed the data for concordance. RESULTS Available fMRI data were diagnostically usable in 92% (33/36 analyzed hemispheres), with DAT anatomic accuracy in the remaining cases. The DAT prediction and fMRI findings were concordant in all 9 normal hemispheres and in 20 (83%) of 24 glioma-bearing hemispheres. The 4 discordant cases resulted from substantial mass effect by large frontal tumors. CONCLUSIONS This study validated DAT's anatomic atlas and alignment process for the expected position of the motor cortex of the hand.
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85
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Borchers S, Himmelbach M, Logothetis N, Karnath HO. Direct electrical stimulation of human cortex - the gold standard for mapping brain functions? Nat Rev Neurosci 2011; 13:63-70. [PMID: 22127300 DOI: 10.1038/nrn3140] [Citation(s) in RCA: 258] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Despite its clinical relevance, direct electrical stimulation (DES) of the human brain is surprisingly poorly understood. Although we understand several aspects of electrical stimulation at the cellular level, surface DES evokes a complex summation effect in a large volume of brain tissue, and the effect is difficult to predict as it depends on many local and remote physiological and morphological factors. The complex stimulation effects are reflected in the heterogeneity of behavioural effects that are induced by DES, which range from evocation to inhibition of responses - sometimes even when DES is applied at the same cortical site. Thus, it is a misconception that DES - in contrast to other neuroscience techniques - allows us to draw unequivocal conclusions about the role of stimulated brain areas.
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Affiliation(s)
- Svenja Borchers
- Center for Neurology, Division of Neuropsychology, University of Tübingen, 72076 Tübingen, Germany
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86
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Automated delineation of white matter fiber tracts with a multiple region-of-interest approach. Neuroimage 2011; 59:3690-700. [PMID: 22155046 DOI: 10.1016/j.neuroimage.2011.11.043] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 11/10/2011] [Accepted: 11/14/2011] [Indexed: 12/13/2022] Open
Abstract
White matter fiber bundles of the brain can be delineated by tractography utilizing multiple regions-of-interest (MROI) defined by anatomical landmarks. These MROI can be used to specify regions in which to seed, select, or reject tractography fibers. Manual identification of anatomical MROI enables the delineation of white matter fiber bundles, but requires considerable training to develop expertise, considerable time to carry out and suffers from unwanted inter- and intra-rater variability. In a study of 20 healthy volunteers, we compared three methodologies for automated delineation of the white matter fiber bundles. Using these methodologies, fiber bundle MROI for each volunteer were automatically generated. We assessed three strategies for inferring the automatic MROI utilizing nonrigid alignment of reference images and projection of template MROI. We assessed the bundle delineation error associated with alignment utilizing T1-weighted MRI, fractional anisotropy images, and full tensor images. We confirmed the smallest delineation error was achieved using the full tensor images. We then assessed three projection strategies for automatic determination of MROI in each volunteer. Quantitative comparisons were made using the root-mean-squared error observed between streamline density images constructed from fiber bundles identified automatically and by manually drawn MROI in the same subjects. We demonstrate that a multiple template consensus label fusion algorithm generated fiber bundles most consistent with the manual reference standard.
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87
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Leclercq D, Delmaire C, de Champfleur NM, Chiras J, Lehéricy S. Diffusion tractography: methods, validation and applications in patients with neurosurgical lesions. Neurosurg Clin N Am 2011; 22:253-68, ix. [PMID: 21435575 DOI: 10.1016/j.nec.2010.11.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Diffusion tensor imaging (DTI) tractography is increasingly used in presurgical mapping in tumors located in eloquent areas since it is the only non invasive technique that permits in vivo dissection of white matter tracts. Concordance between the DTI tracts and subcortical electrical intraoperative mapping is high, and DTI tractography has proven useful to guide surgery. However, it presents limitations due to the technique and the tumor, which must be known before using the images in the operative room. This review focuses on the possibilities and limits of DTI imaging in intraoperative tumoral mapping and presents an overview of current knowledge.
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Affiliation(s)
- Delphine Leclercq
- Centre de NeuroImagerie de Recherche-CENIR, Groupe Hospitalier Pitié-Salpêtrière 47-83, Bd de l'Hôpital, 75013 Paris, France.
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