1
|
Dmitriev AY, Dashyan VG. [Intraoperative magnetic resonance imaging in surgery of brain gliomas]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:121-127. [PMID: 35170285 DOI: 10.17116/neiro202286011121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intraoperative magnetic resonance imaging (iMRI) is used in surgery of supratentorial gliomas to assess resection quality, as well as in neoplasm biopsy to control the needle position. Scanners coupled with operating table ensure fast intraoperative imaging, but they require the use of non-magnetic surgical tools. Surgery outside the scanner 5G line allows working with conventional instruments, but patient transportation takes time. Portable iMRI systems do not interfere with surgical workflow but these scanners have poor resolution. Positioning of MRI scanners in adjacent rooms allows imaging simultaneously for several surgeries. Low-field MRI scanners are effective for control of contrast-enhanced glioma resection quality. However, these scanners are less useful in demarcation of residual low-grade tumors. High-field MRI scanners have no similar disadvantage. These scanners ensure fast detection of residual gliomas of all types and functional imaging. Artifacts during iMRI are usually a result of iatrogenic traumatic brain injury and contrast agent leakage. Ways of their prevention are discussed in the review.
Collapse
Affiliation(s)
- A Yu Dmitriev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - V G Dashyan
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| |
Collapse
|
2
|
Saß B, Pojskic M, Bopp M, Nimsky C, Carl B. Comparing Fiducial-Based and Intraoperative Computed Tomography-Based Registration for Frameless Stereotactic Brain Biopsy. Stereotact Funct Neurosurg 2020; 99:79-89. [PMID: 32992321 DOI: 10.1159/000510007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this work was to compare fiducial-based and intraoperative computed tomography (iCT)-based registration for frameless stereotactic brain biopsy. METHODS Of 50 frameless stereotactic biopsies with the VarioGuide, 30 cases were registered as iCT based and 20 as fiducial based. Statistical analysis of the target registration error (TRE), dose length product, effective radiation dose (ED), operation time, and diagnostic yield was performed. RESULTS The mean TRE was significantly lower using iCT-based registration (mean ± SD: 0.70 ± 0.32 vs. 2.43 ± 0.73 mm, p < 0.0001). The ED was significantly lower when using iCT-based registration compared to standard navigational CT (mean ± SD: 0.10 ± 0.13 vs. 2.23 ± 0.34 mSv, p < 0.0001). Post-biopsy iCT was associated with a significant lower (p < 0.0001) ED compared to standard CT (mean ± SD: 1.04 ± 0.18 vs. 1.65 ± 0.26 mSv). The mean surgical time was shorter using iCT-based registration, although the mean total operating room (OR) time did not differ significantly. The diagnostic yield was 96.7% (iCT group) versus 95% (fiducial group). Post-biopsy imaging revealed severe bleeding in 3.3% (iCT group) versus 5% (fiducial group). CONCLUSION iCT-based registration for frameless stereotactic biopsies increases the accuracy significantly without negative effects on the surgical time or the overall time in the OR. Appropriate scan protocols in iCT registration contribute to a significant reduction of the radiation exposure. The high accuracy of the iCT makes it the more favorable registration strategy when taking biopsies of small tumors or lesions near eloquent brain areas.
Collapse
Affiliation(s)
- Benjamin Saß
- Department of Neurosurgery, University Marburg, Marburg, Germany,
| | - Mirza Pojskic
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Miriam Bopp
- Department of Neurosurgery, University Marburg, Marburg, Germany.,Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University Marburg, Marburg, Germany.,Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Barbara Carl
- Department of Neurosurgery, University Marburg, Marburg, Germany.,Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| |
Collapse
|
3
|
Mu Y, Li Y, Zhang Q, Ding Z, Wang M, Luo X, Guo X, Xu M. Amplitude of low-frequency fluctuations on Alzheimer's disease with depression: evidence from resting-state fMRI. Gen Psychiatr 2020; 33:e100147. [PMID: 32695958 PMCID: PMC7351268 DOI: 10.1136/gpsych-2019-100147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/20/2020] [Accepted: 06/03/2020] [Indexed: 11/12/2022] Open
Abstract
Background The prevalence of Alzheimer’s disease (AD) comorbid with depression is common. However, the mechanisms of AD with depression remain unclear. Aims To investigate the regional alterations of brain activity of AD with depression in resting-state functional magnetic resonance imaging (rs-fMRI). Methods 154 patients with AD who met the inclusion criteria were recruited from the Zhejiang Provincial People’s Hospital from October 2014 to October 2016. According to whether the core symptoms of depression were present, patients were divided into two groups, 22 patients with AD with depression (AD-D) and 52 patients with AD without depression (AD-nD). The amplitude of low frequency fluctuations (ALFF) was compared between two groups by performing independent-samples t-test. Results Compared with the AD-D group, increased ALFF values in the bilateral superior frontal gyrus, left middle frontal gyrus and left inferior frontal gyrus were observed in the AD-nD group. The brain activity in the AD-nD group in the bilateral superior frontal gyrus, left middle frontal gyrus and the left inferior frontal gyrus was higher than the AD-D group. Conclusions Resting-state brain functional alterations may be closely bound up with the pathophysiologic features of patients with AD with depressive symptoms.
Collapse
Affiliation(s)
- Yuzhu Mu
- Department of Ultrasound, the First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yumei Li
- Department of Radiology, Zhejiang Provincial People's Hospital, Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qi Zhang
- Department of Radiology, the First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhongxiang Ding
- Translational Medicine Research Center, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mei Wang
- Translational Medicine Research Center, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Xiaoyun Guo
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Maosheng Xu
- Department of Radiology, the First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
4
|
Zhang P, Liu H, Sun Z, Wang J, Wang G. The Application of O-arm and Navigation System in Precise Localization of Spinal Cord lesions: a Case Series study. Clin Neurol Neurosurg 2020; 196:105922. [PMID: 32622109 DOI: 10.1016/j.clineuro.2020.105922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study on the clinical efficacy of precise localization of O-arm and navigation system in spinal cord lesions. METHODS From Augst 2015 to September 2019, 22 patients with spinal cord lesions were arranged in the group.The intraoperative cross-sectional images were acquired by O-arm image system, which were transferred to the Stealth navigation system, and fused with pre-opreative MRI images. The image fusion was completed by the Medtronic Synergy Cranial software. The fused images were used to locate spinal cord lesions, assisted by the navigation system. The navigation errors were evaluated by measuring the maximum distance between the end of the lesion in MRI and its real position. RESULTS The image fusion were completed in all patients, and we successfully completed the image-guided surgeries of the spinal cord lesions. The time of image processing was between 7 min and 19 min, and the mean value was 15.1 ± 2.2 min. The navigation error was between 0.9 mm and 5.3 mm, the mean value was 1.6 ± 0.9 mm. CONCLUSION The application of precise localization of O-arm and navigation system in spinal cord lesions is clinically reliable and feasible.
Collapse
Affiliation(s)
- Peihai Zhang
- Department of neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China.
| | - Huiting Liu
- Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zhenxing Sun
- Department of neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China
| | - James Wang
- Department of neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China
| | - Guihuai Wang
- Department of neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China.
| |
Collapse
|
5
|
Dorfer C, Rydenhag B, Baltuch G, Buch V, Blount J, Bollo R, Gerrard J, Nilsson D, Roessler K, Rutka J, Sharan A, Spencer D, Cukiert A. How technology is driving the landscape of epilepsy surgery. Epilepsia 2020; 61:841-855. [PMID: 32227349 PMCID: PMC7317716 DOI: 10.1111/epi.16489] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/24/2022]
Abstract
This article emphasizes the role of the technological progress in changing the landscape of epilepsy surgery and provides a critical appraisal of robotic applications, laser interstitial thermal therapy, intraoperative imaging, wireless recording, new neuromodulation techniques, and high-intensity focused ultrasound. Specifically, (a) it relativizes the current hype in using robots for stereo-electroencephalography (SEEG) to increase the accuracy of depth electrode placement and save operating time; (b) discusses the drawback of laser interstitial thermal therapy (LITT) when it comes to the need for adequate histopathologic specimen and the fact that the concept of stereotactic disconnection is not new; (c) addresses the ratio between the benefits and expenditure of using intraoperative magnetic resonance imaging (MRI), that is, the high technical and personnel expertise needed that might restrict its use to centers with a high case load, including those unrelated to epilepsy; (d) soberly reviews the advantages, disadvantages, and future potentials of neuromodulation techniques with special emphasis on the differences between closed and open-loop systems; and (e) provides a critical outlook on the clinical implications of focused ultrasound, wireless recording, and multipurpose electrodes that are already on the horizon. This outlook shows that although current ultrasonic systems do have some limitations in delivering the acoustic energy, further advance of this technique may lead to novel treatment paradigms. Furthermore, it highlights that new data streams from multipurpose electrodes and wireless transmission of intracranial recordings will become available soon once some critical developments will be achieved such as electrode fidelity, data processing and storage, heat conduction as well as rechargeable technology. A better understanding of modern epilepsy surgery will help to demystify epilepsy surgery for the patients and the treating physicians and thereby reduce the surgical treatment gap.
Collapse
Affiliation(s)
- Christian Dorfer
- Department of NeurosurgeryMedical University of ViennaViennaAustria
| | - Bertil Rydenhag
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologyThe Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of NeurosurgerySahlgrenska University HospitalGothenburgSweden
| | - Gordon Baltuch
- Center for Functional and Restorative NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Vivek Buch
- Center for Functional and Restorative NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Jeffrey Blount
- Division of NeurosurgeryUniversity of Alabama at Birmingham School of MedicineBirminghamALUSA
| | - Robert Bollo
- Department of NeurosurgeryUniversity of Utah School of MedicineSalt Lake CityUTUSA
| | - Jason Gerrard
- Department of NeurosurgeryYale University School of MedicineNew HavenCTUSA
| | - Daniel Nilsson
- Department of Clinical NeuroscienceInstitute of Neuroscience and PhysiologyThe Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of NeurosurgerySahlgrenska University HospitalGothenburgSweden
| | - Karl Roessler
- Department of NeurosurgeryMedical University of ViennaViennaAustria
- Department of NeurosurgeryUniversity of ErlangenErlangenGermany
| | - James Rutka
- Division of Pediatric NeurosurgeryThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Ashwini Sharan
- Department of Neurosurgery and NeurologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Dennis Spencer
- Department of NeurosurgeryYale University School of MedicineNew HavenCTUSA
| | - Arthur Cukiert
- Neurology and Neurosurgery Clinic Sao PauloClinica Neurologica CukiertSao PauloBrazil
| |
Collapse
|
6
|
Feigl GC, Heckl S, Kullmann M, Filip Z, Decker K, Klein J, Ernemann U, Tatagiba M, Velnar T, Ritz R. Review of first clinical experiences with a 1.5 Tesla ceiling-mounted moveable intraoperative MRI system in Europe. Bosn J Basic Med Sci 2019; 19:24-30. [PMID: 30589401 PMCID: PMC6387677 DOI: 10.17305/bjbms.2018.3777] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 07/29/2018] [Indexed: 11/16/2022] Open
Abstract
High-field intraoperative MRI (iMRI) systems provide excellent imaging quality and are used for resection control and update of image guidance systems in a number of centers. A ceiling-mounted intraoperative MRI system has several advantages compared to a conventional iMRI system. In this article, we report on first clinical experience with using such a state-of-the-art, the 1.5T iMRI system, in Europe. A total of 50 consecutive patients with intracranial tumors and vascular lesions were operated in the iMRI unit. We analyzed the patients' data, surgery preparation times, intraoperative scans, surgical time, and radicality of tumor removal. Patients' mean age was 46 years (range 8 to 77 years) and the median surgical procedure time was 5 hours (range 1 to 11 hours). The lesions included 6 low-grade gliomas, 8 grade III astrocytomas, 10 glioblastomas, 7 metastases, 7 pituitary adenomas, 2 cavernomas, 2 lymphomas, 1 cortical dysplasia, 3 aneurysms, 1 arterio-venous malformation and 1 extracranial-intracranial bypass, 1 clival chordoma, and 1 Chiari malformation. In the surgical treatment of tumor lesions, intraoperative imaging depicted tumor remnant in 29.7% of the cases, which led to a change in the intraoperative strategy. The mobile 1.5T iMRI system proved to be safe and allowed an optimal workflow in the iMRI unit. Due to the fact that the MRI scanner is moved into the operating room only for imaging, the working environment is comparable to a regular operating room.
Collapse
Affiliation(s)
- Guenther C Feigl
- Department of Neurosurgery, University of Tuebingen Medical Center, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Zhang P, Wang G, Sun Z, Lv X, Guo Y, Wang J, Wu Y, Shi W, Zhang H, Liu H, Lu Y. Application of Multimodal Image Fusion to Precisely Localize Small Intramedullary Spinal Cord Tumors. World Neurosurg 2018; 118:246-249. [PMID: 30031956 DOI: 10.1016/j.wneu.2018.07.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We sought to study the application of precise intraoperative localization of small intramedullary spinal cord tumors. METHODS From November 2015 to August 2017, 5 patients with small intramedullary spinal cord tumors were arranged in this group. By using the O-arm image system, we acquired the intraoperative computed tomography images of all patients and sent them to the Stealth navigation system. Medtronic Synergy Cranial software was used to complete the image fusion with preoperative magnetic resonance images, and the fused images were used to localize the intramedullary spinal cord tumors by the navigation system. The navigation errors were evaluated by measuring the maximum distance between the end of the tumor in sagittal magnetic resonance imaging and its real position. RESULTS Five patients accomplished the multimodal image fusion, and we successfully completed the image-guided surgeries. The mean diameter of tumors was 12.2 ± 3.1 mm in sagittal magnetic resonance imaging, and the mean incision length was 12.7 ± 3.3 mm. The time of image processing was between 13 minutes and 17 minutes, and the mean value was 15 ± 1.6 minutes. The navigation error was between 0.9 mm and 1.5 mm, and the mean value was 1.2 ± 0.2 mm. CONCLUSIONS The application of the multimodal image fusion combined with intraoperative O-arm image navigation system can be used to localize small intramedullary tumors.
Collapse
Affiliation(s)
- Peihai Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Guihuai Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Zhenxing Sun
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yi Guo
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - James Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Youtu Wu
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Wei Shi
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Huifang Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Huiting Liu
- Peking Union Medical University Hospital, Beijing, China
| | - Yang Lu
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| |
Collapse
|
8
|
Zhang JS, Qu L, Wang Q, Jin W, Hou YZ, Sun GC, Li FY, Yu XG, Xu BN, Chen XL. Intraoperative visualisation of functional structures facilitates safe frameless stereotactic biopsy in the motor eloquent regions of the brain. Br J Neurosurg 2017; 32:372-380. [PMID: 29260585 DOI: 10.1080/02688697.2017.1416059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND For stereotactic brain biopsy involving motor eloquent regions, the surgical objective is to enhance diagnostic yield and preserve neurological function. To achieve this aim, we implemented functional neuro-navigation and intraoperative magnetic resonance imaging (iMRI) into the biopsy procedure. The impact of this integrated technique on the surgical outcome and postoperative neurological function was investigated and evaluated. METHOD Thirty nine patients with lesions involving motor eloquent structures underwent frameless stereotactic biopsy assisted by functional neuro-navigation and iMRI. Intraoperative visualisation was realised by integrating anatomical and functional information into a navigation framework to improve biopsy trajectories and preserve eloquent structures. iMRI was conducted to guarantee the biopsy accuracy and detect intraoperative complications. The perioperative change of motor function and biopsy error before and after iMRI were recorded, and the role of functional information in trajectory selection and the relationship between the distance from sampling site to nearby eloquent structures and the neurological deterioration were further analyzed. RESULTS Functional neuro-navigation helped modify the original trajectories and sampling sites in 35.90% (16/39) of cases to avoid the damage of eloquent structures. Even though all the lesions were high-risk of causing neurological deficits, no significant difference was found between preoperative and postoperative muscle strength. After data analysis, 3mm was supposed to be the safe distance for avoiding transient neurological deterioration. During surgery, the use of iMRI significantly reduced the biopsy errors (p = 0.042) and potentially increased the diagnostic yield from 84.62% (33/39) to 94.87% (37/39). Moreover, iMRI detected intraoperative haemorrhage in 5.13% (2/39) of patients, all of them benefited from the intraoperative strategies based on iMRI findings. CONCLUSIONS Intraoperative visualisation of functional structures could be a feasible, safe and effective technique. Combined with intraoperative high-field MRI, it contributed to enhance the biopsy accuracy and lower neurological complications in stereotactic brain biopsy involving motor eloquent areas.
Collapse
Affiliation(s)
- Jia-Shu Zhang
- a Department of Neurosurgery , General Hospital , Beijing , China
| | - Ling Qu
- b Neurosurgery Department of Chinese PLA General Hospital , Beijing , China
| | - Qun Wang
- a Department of Neurosurgery , General Hospital , Beijing , China
| | - Wei Jin
- c Pathology Department of Chinese PLA General Hospital , Beijing , China
| | - Yuan-Zheng Hou
- a Department of Neurosurgery , General Hospital , Beijing , China
| | - Guo-Chen Sun
- a Department of Neurosurgery , General Hospital , Beijing , China
| | - Fang-Ye Li
- a Department of Neurosurgery , General Hospital , Beijing , China
| | - Xin-Guang Yu
- a Department of Neurosurgery , General Hospital , Beijing , China
| | - Ban-Nan Xu
- a Department of Neurosurgery , General Hospital , Beijing , China
| | - Xiao-Lei Chen
- a Department of Neurosurgery , General Hospital , Beijing , China
| |
Collapse
|
9
|
Buchfelder M, Zhao Y. Is awake surgery for supratentorial adult low-grade gliomas the gold standard? Neurosurg Rev 2017; 41:1-2. [DOI: 10.1007/s10143-017-0916-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
10
|
Intraoperative high-field magnetic resonance imaging, multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas. Chronic Dis Transl Med 2017; 2:181-188. [PMID: 29063040 PMCID: PMC5643761 DOI: 10.1016/j.cdtm.2016.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Indexed: 11/25/2022] Open
Abstract
Objective To determine the beneficial effects of intraoperative high-field magnetic resonance imaging (MRI), multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas. Methods Twelve patients with 13 supratentorial cavernomas were prospectively enrolled and operated while using a 1.5 T intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. All cavernomas were deeply located in subcortical areas or involved critical areas. Intraoperative high-field MRIs were obtained for the intraoperative “visualization” of surrounding eloquent structures, “brain shift” corrections, and navigational plan updates. Results All cavernomas were successfully resected with guidance from intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. In 5 cases with supratentorial cavernomas, intraoperative “brain shift” severely deterred locating of the lesions; however, intraoperative MRI facilitated precise locating of these lesions. During long-term (>3 months) follow-up, some or all presenting signs and symptoms improved or resolved in 4 cases, but were unchanged in 7 patients. Conclusions Intraoperative high-field MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring are helpful in surgeries for the treatment of small deeply seated subcortical cavernomas.
Collapse
|
11
|
Costa F, Ortolina A, Cardia A, Riva M, Revay M, Pecchioli G, Anania CD, Asteggiano F, Fornari M. Preoperative Magnetic Resonance and Intraoperative Computed Tomography Fusion for Real-Time Neuronavigation in Intramedullary Lesion Surgery. Oper Neurosurg (Hagerstown) 2017; 13:188-195. [PMID: 28927206 DOI: 10.1093/ons/opw005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Image-guided surgery techniques in spinal surgery are usually based upon fluoroscopy or computed tomography (CT) scan, which allow for a real-time navigation of bony structures, though not of neural structures and soft tissue remains. OBJECTIVE To verify the effectiveness and efficacy of a novel technique of imaging merging between preoperative magnetic resonance imaging (MRI) and intraoperative CT scan during removal of intramedullary lesions. METHODS Ten consecutive patients were treated for intramedullary lesions using a navigation system aid. Preoperative contrast-enhanced MRI was merged in the navigation software, with an intraoperative CT acquisition, performed using the O-arm TM system (Medtronic Sofamor Danek, Minneapolis, Minnesota). Dosimetric and timing data were also acquired for each patient. RESULTS The fusion process was achieved in all cases and was uneventful. The merged imaging information was useful in all cases for defining the exact area of laminectomy, dural opening, and the eventual extension of cordotomy, without requiring exposition corrections. The radiation dose for the patients was 0.78 mSv. Using the authors' protocol, it was possible to merge a preoperative MRI with navigation based on intraoperative CT scanning in all cases. Information gained with this technique was useful during the different surgical steps. However, there were some drawbacks, such as the merging process, which still remains partially manual. CONCLUSION In this initial experience, MRI and CT merging and its feasibility were tested, and we appreciated its safety, precision, and ease.
Collapse
Affiliation(s)
- Francesco Costa
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Alessandro Ortolina
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Andrea Cardia
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Marco Riva
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Martina Revay
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Guido Pecchioli
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Carla Daniela Anania
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Francesco Asteggiano
- Departments of Radiology, Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Maurizio Fornari
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| |
Collapse
|
12
|
Bai SC, Xu BN, Wei SH, Geng JF, Wu DD, Yu XG, Chen XL. Intraoperative high-field magnetic resonance imaging combined with functional neuronavigation in resection of low-grade temporal lobe tumors. World J Surg Oncol 2015; 13:286. [PMID: 26410079 PMCID: PMC4583990 DOI: 10.1186/s12957-015-0690-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/07/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The aim of this study is to investigate the role of intraoperative MR imaging in temporal lobe low-grade glioma (LGG) surgery and to report the surgical outcome in our series with regard to seizures, neurological defects, and quality of life. METHODS Patients with temporal lobe contrast-nonenhancing gliomas who presented with seizures in the course of their disease were enrolled in our prospective study. We non-randomly assigned patients to undergo intraoperative magnetic resonance imaging (iMRI)-guided surgery or conventional surgery. Extent of resection (EOR) and surgical outcomes were compared between the two groups. RESULTS Forty-one patients were allocated in the iMRI group, and 14 were in the conventional group. Comparable EOR was achieved for the two groups (p = 0.634) although preoperative tumor volumes were significantly larger for the iMRI group. Seizure outcome tended to be better for the iMRI group (Engel class I achieved for 89.7% (35/39) vs 75% (9/12)) although this difference was not statistically different. Newly developed neurological deficits were observed in four patients (10.3%) and two patients (16.7%), respectively (p = 0.928). Free of seizures and neurological morbidity led to a return-to-work or return-to-school rate of 84.6% (33/39) vs 75% (9/12), respectively (p = 0.741). CONCLUSIONS Our study provided evidence that iMRI was a safe and useful tool in temporal lobe LGG surgery. Optimal extent of resection contributed to favorable seizure outcome in our series with low morbidity rate, which led to a high return-to-work rate.
Collapse
Affiliation(s)
- Shao-cong Bai
- Department of Neurosurgery, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Bai-nan Xu
- Department of Neurosurgery, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Shi-hui Wei
- Department of Ophthalmology, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Jie-feng Geng
- Department of Neurosurgery, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Dong-dong Wu
- Department of Neurosurgery, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Xin-guang Yu
- Department of Neurosurgery, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Xiao-lei Chen
- Department of Neurosurgery, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| |
Collapse
|
13
|
Mert A, Kiesel B, Wöhrer A, Martínez-Moreno M, Minchev G, Furtner J, Knosp E, Wolfsberger S, Widhalm G. Introduction of a standardized multimodality image protocol for navigation-guided surgery of suspected low-grade gliomas. Neurosurg Focus 2015; 38:E4. [PMID: 25552284 DOI: 10.3171/2014.10.focus14597] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgery of suspected low-grade gliomas (LGGs) poses a special challenge for neurosurgeons due to their diffusely infiltrative growth and histopathological heterogeneity. Consequently, neuronavigation with multimodality imaging data, such as structural and metabolic data, fiber tracking, and 3D brain visualization, has been proposed to optimize surgery. However, currently no standardized protocol has been established for multimodality imaging data in modern glioma surgery. The aim of this study was therefore to define a specific protocol for multimodality imaging and navigation for suspected LGG. METHODS Fifty-one patients who underwent surgery for a diffusely infiltrating glioma with nonsignificant contrast enhancement on MRI and available multimodality imaging data were included. In the first 40 patients with glioma, the authors retrospectively reviewed the imaging data, including structural MRI (contrast-enhanced T1-weighted, T2-weighted, and FLAIR sequences), metabolic images derived from PET, or MR spectroscopy chemical shift imaging, fiber tracking, and 3D brain surface/vessel visualization, to define standardized image settings and specific indications for each imaging modality. The feasibility and surgical relevance of this new protocol was subsequently prospectively investigated during surgery with the assistance of an advanced electromagnetic navigation system in the remaining 11 patients. Furthermore, specific surgical outcome parameters, including the extent of resection, histological analysis of the metabolic hotspot, presence of a new postoperative neurological deficit, and intraoperative accuracy of 3D brain visualization models, were assessed in each of these patients. RESULTS After reviewing these first 40 cases of glioma, the authors defined a specific protocol with standardized image settings and specific indications that allows for optimal and simultaneous visualization of structural and metabolic data, fiber tracking, and 3D brain visualization. This new protocol was feasible and was estimated to be surgically relevant during navigation-guided surgery in all 11 patients. According to the authors' predefined surgical outcome parameters, they observed a complete resection in all resectable gliomas (n = 5) by using contour visualization with T2-weighted or FLAIR images. Additionally, tumor tissue derived from the metabolic hotspot showed the presence of malignant tissue in all WHO Grade III or IV gliomas (n = 5). Moreover, no permanent postoperative neurological deficits occurred in any of these patients, and fiber tracking and/or intraoperative monitoring were applied during surgery in the vast majority of cases (n = 10). Furthermore, the authors found a significant intraoperative topographical correlation of 3D brain surface and vessel models with gyral anatomy and superficial vessels. Finally, real-time navigation with multimodality imaging data using the advanced electromagnetic navigation system was found to be useful for precise guidance to surgical targets, such as the tumor margin or the metabolic hotspot. CONCLUSIONS In this study, the authors defined a specific protocol for multimodality imaging data in suspected LGGs, and they propose the application of this new protocol for advanced navigation-guided procedures optimally in conjunction with continuous electromagnetic instrument tracking to optimize glioma surgery.
Collapse
|
14
|
Impact of intraoperative magnetic resonance imaging and functional neuronavigation on surgical outcome in patients with gliomas involving language areas. Neurosurg Rev 2014; 38:319-30; discussion 330. [DOI: 10.1007/s10143-014-0585-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/21/2014] [Accepted: 06/22/2014] [Indexed: 11/26/2022]
|
15
|
Tabatabai G, Hattingen E, Schlegel J, Stummer W, Schlegel U. [Interdisciplinary neuro-oncology: part 1: diagnostics and operative therapy of primary brain tumors]. DER NERVENARZT 2014; 85:965-75. [PMID: 25037493 DOI: 10.1007/s00115-014-4041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
By combining the expertise of clinical neuroscience, the aim of neuro-oncology is to optimize diagnostic planning and therapy of primary brain tumors in an interdisciplinary setting together with radio-oncology and medical oncology. High-end imaging frequently allows brain tumors to be diagnosed preoperatively with respect to tumor entity and even tumor malignancy grade. Moreover, neuroimaging is indispensable for guidance of biopsy resection and monitoring of therapy. Surgical resection of intracranial lesions with preservation of neurological function is increasingly feasible. Tools to achieve this goal are, for example neuronavigation, functional magnetic resonance imaging (fMRI), tractography, intraoperative cortical stimulation and precise intraoperative definition of tumor margins by virtue of various techniques. In addition to classical histopathological diagnosis and tumor classification, modern neuropathology is supplemented by molecular characterization of brain tumors in order to provide clinicians with prognostic and predictive (of therapy) markers, such as codeletion of chromosomes 1p and 19q in anaplastic gliomas and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in glioblastomas. Although this is not yet individualized tumor therapy, the increasingly more detailed analysis of the molecular pathogenesis of an individual glioma will eventually lead to specific pharmacological blockade of disturbed intracellular pathways in individual patients. This article gives an overview of the state of the art of interdisciplinary neuro-oncology whereby part 1 deals with the diagnostics and surgical therapy of primary brain tumors and part 2 describes the medical therapy of primary brain tumors.
Collapse
Affiliation(s)
- G Tabatabai
- Interdisziplinäre Sektion für Neuroonkologie, Klinik für Neurochirurgie, Zentrum für Neurologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | | | | | | | | |
Collapse
|
16
|
Sommer B, Kasper BS, Coras R, Blumcke I, Hamer HM, Buchfelder M, Roessler K. Surgical management of epilepsy due to cerebral cavernomas using neuronavigation and intraoperative MR imaging. Neurol Res 2013; 35:1076-83. [PMID: 24083819 PMCID: PMC3823933 DOI: 10.1179/016164113x13801151880551] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives: Cure from seizures due to cavernomas might be surgically achieved dependent on both, the complete removal of the cavernoma as well as its surrounding hemosiderin rim. High field intraoperative MRI imaging (iopMRI) and neuronavigation might play a crucial role to achieve both goals. We retrospectively investigated the long-term results and impact of intraoperative 1·5T MRI (iopMRI) and neuronavigation on the completeness of surgical removal of a cavernous malformation (CM) and its perilesional hemosiderin rim as well as reduction of surgical morbidity. Methods: 26 patients (14 female, 12 male, mean age 39·1 years, range: 17–63 years) with CM related epilepsy were identified. Eighteen patients suffered from drug resistant epilepsy (69·2%). Mean duration of epilepsy was 11·9 years in subjects with drug resistant epilepsy (n = 18) and 0·3 years in subjects presenting with first-time seizures (n = 8). We performed 24 lesionectomies and two lesionectomies combined with extended temporal resections. Seven lesions were located extratemporally. Results: Complete CM removal was documented by postsurgical MRI in all patients. As direct consequence of iopMRI, refined surgery was necessary in 11·5% of patients to achieve complete cavernoma removal and in another 11·5% for complete resection of additional adjacent epileptogenic cortex. Removal of the hemosiderin rim was confirmed by iopMRI in 92% of patients. Two patients suffered from mild (7·7%) and one from moderate (3·8%) visual field deficits. Complete seizure control (Engel class 1A) was achieved in 80·8% of patients with a mean follow-up period of 47·7 months. Discussion: We report excellent long-term seizure control with minimal surgical morbidity after complete resection of CM using our multimodal approach.
Collapse
|
17
|
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.
Collapse
Affiliation(s)
- Roman Rodionov
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK; Epilepsy Society, MRI Unit, Chalfont St Peter, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Orringer DA, Golby A, Jolesz F. Neuronavigation in the surgical management of brain tumors: current and future trends. Expert Rev Med Devices 2013; 9:491-500. [PMID: 23116076 DOI: 10.1586/erd.12.42] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neuronavigation has become an ubiquitous tool in the surgical management of brain tumors. This review describes the use and limitations of current neuronavigational systems for brain tumor biopsy and resection. Methods for integrating intraoperative imaging into neuronavigational datasets developed to address the diminishing accuracy of positional information that occurs over the course of brain tumor resection are discussed. In addition, the process of integration of functional MRI and tractography into navigational models is reviewed. Finally, emerging concepts and future challenges relating to the development and implementation of experimental imaging technologies in the navigational environment are explored.
Collapse
Affiliation(s)
- Daniel A Orringer
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | | | | |
Collapse
|
19
|
Li J, Chen X, Zhang J, Zheng G, Lv X, Li F, Hu S, Zhang T, Xu B. Intraoperative diffusion tensor imaging predicts the recovery of motor dysfunction after insular lesions. Neural Regen Res 2013; 8:1400-9. [PMID: 25206435 PMCID: PMC4107766 DOI: 10.3969/j.issn.1673-5374.2013.15.007] [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: 02/11/2013] [Accepted: 04/02/2013] [Indexed: 12/02/2022] Open
Abstract
Insular lesions remain surgically challenging because of the need to balance aggressive resection and functional protection. Motor function deficits due to corticospinal tract injury are a common complication of surgery for lesions adjacent to the internal capsule and it is therefore essential to evaluate the corticospinal tract adjacent to the lesion. We used diffusion tensor imaging to evaluate the corticospinal tract in 89 patients with insular lobe lesions who underwent surgery in Chinese PLA General Hospital from February 2009 to May 2011. Postoperative motor function evaluation revealed that 57 patients had no changes in motor function, and 32 patients suffered motor dysfunction or aggravated motor dysfunction. Of the affected patients, 20 recovered motor function during the 6–12-month follow-up, and an additional 12 patients did not recover over more than 12 months of follow-up. Following reconstruction of the corticospinal tract, fractional anisotropy comparison demonstrated that preoperative, intraoperative and follow-up normalized fractional anisotropy in the stable group was higher than in the transient deficits group or the long-term deficits group. Compared with the transient deficits group, intraoperative normalized fractional anisotropy significantly decreased in the long-term deficits group. We conclude that intraoperative fractional anisotropy values of the corticospinal tracts can be used as a prognostic indicator of motor function outcome.
Collapse
Affiliation(s)
- Jinjiang Li
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiaolei Chen
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Jiashu Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Gang Zheng
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Xueming Lv
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Fangye Li
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Shen Hu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Ting Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Bainan Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|
20
|
Sommer B, Grummich P, Coras R, Kasper BS, Blumcke I, Hamer HM, Stefan H, Buchfelder M, Roessler K. Integration of functional neuronavigation and intraoperative MRI in surgery for drug-resistant extratemporal epilepsy close to eloquent brain areas. Neurosurg Focus 2013; 34:E4. [DOI: 10.3171/2013.2.focus12397] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors performed a retrospective study to assess the impact of functional neuronavigation and intraoperative MRI (iMRI) on surgery of extratemporal epileptogenic lesions on postsurgical morbidity and seizure control.
Methods
Twenty-five patients (14 females and 11 males) underwent extratemporal resections for drug-resistant epilepsy close to speech/motor brain areas or adjacent to white matter tracts. The mean age at surgery was 34 years (range 12–67 years). The preoperative mean disease duration was 13.2 years. To avoid awake craniotomy, cortical motor-sensory representation was mapped during preoperative evaluation in 14 patients and speech representation was mapped in 15 patients using functional MRI. In addition, visualization of the pyramidal tract was performed in 11 patients, of the arcuate fascicle in 7 patients, and of the visual tract in 6 patients using diffusion tensor imaging. The mean minimum distance of tailored resection between the eloquent brain areas was 5.6 mm. During surgery, blood oxygen level–dependent imaging and diffusion tensor imaging data were integrated into neuronavigation and displayed through the operating microscope. The postoperative mean follow-up was 44.2 months.
Results
In 20% of these patients, further intraoperative resection was performed because of intraoperatively documented residual lesions according to iMRI findings. At the end of resection, the final iMRI scans confirmed achievement of total resection of the putative epileptogenic lesion in all patients. Postoperatively, transient complications and permanent complications were observed in 20% and 12% of patients, respectively. Favorable postoperative seizure control (Engel Classes I and II) was achieved in 84% and seizure freedom in 72% of these consecutive surgical patients.
Conclusions
By using functional neuronavigation and iMRI for treatment of epileptogenic brain lesions, the authors achieved a maximum extent of resection despite the lesions' proximity to eloquent brain cortex and fiber tracts in all cases. The authors' results underline possible benefits of this technique leading to a favorable seizure outcome with acceptable neurological deficit rates in difficult-to-treat extratemporal epilepsy.
Collapse
Affiliation(s)
| | | | - Roland Coras
- 3Neuropathology, University Hospital Erlangen, Germany
| | | | | | | | | | | | | |
Collapse
|
21
|
The dangers of magnetic resonance imaging diffusion tensor tractography in brain surgery. World Neurosurg 2013; 81:56-8. [PMID: 23376386 DOI: 10.1016/j.wneu.2013.01.116] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 01/28/2013] [Indexed: 01/24/2023]
|