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Sung MF, Lim JH. Ataxic hemiparesis: a narrative review for clinical practice in rehabilitation. Top Stroke Rehabil 2024; 31:537-545. [PMID: 37965878 DOI: 10.1080/10749357.2023.2281722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/04/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Ataxic hemiparesis (AH) is a well-recognized clinical lacunar stroke syndrome, characterized by paresis with ataxia on the same side of the body. It affects patients with stroke involving the basal ganglia, pons, internal capsule, corona radiata, and thalamus. In the past, lacunar syndrome denotes good functional recovery with low mortality and morbidity rate. However, recent evidence suggests AH has an association with more debilitating outcomes in the long term. OBJECTIVE To provide a comprehensive narrative review of published literatures on the topics related with AH and update clinical practice including rehabilitation. METHODS Literature review was performed by using the keywords "Subcortical Ataxia," "Lacunar Stroke," "Diaschisis", and "Ataxic Hemiparesis" on PubMed and Google Scholar Engines from 1978 to 2022. All papers published in English were reviewed and manual search of references from retrieved literature was performed for other relevant articles. RESULTS A comprehensive review was carried out on the following topics: neuroanatomical localization, pathogenesis, clinical features and clinical assessment scales, pharmacological and non-pharmacological modalities for ataxia treatment, prognosis, and outcome. CONCLUSION AH imposes significant challenges on stroke survivors when it comes to remediation of balance and coordination. It is associated with increased risk of mortality, stroke recurrence, and dementia. Though application of the concept of neuroplasticity and the utilization of repetitive transcranial magnetic stimulation have shown early promising results, further research is needed to establish the practice guidelines for rehabilitation of patients with AH.
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Affiliation(s)
- Mei-Fen Sung
- Division of Rehabilitation Medicine, University Medicine Cluster, National University Hospital, Singapore
| | - Jeong Hoon Lim
- Division of Rehabilitation Medicine, University Medicine Cluster, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Sharma M, Plou PL, Gunawan K, Ivan M, Chen CC. Survey Assessment of Utility in Preoperative Magnetic Resonance (MR) Tractography Surgical Planning. World Neurosurg 2023; 180:e468-e473. [PMID: 37774789 DOI: 10.1016/j.wneu.2023.09.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Although tractography-guided surgery is used by many surgeons, there is controversy in the published literature as it relates to its clinical utility. Here we adopted a survey-based approach with the goal of attaining a broader view of how tractography influence preoperative planning in a sampling of practicing neurosurgeons. METHODS Three cases were prepared where the presence of a tumor distorted the optic radiation (case 1), arcuate fasciculus (case 2), and corticospinal tract (case 3). This survey was administered at the Medtronic Cranial Consortium attended by 20 practicing neurosurgeons. To avoid commercial bias, we used both the Brainlab and Medtronic platform to compute tractography. Each participant is asked to vote on a surgical trajectory before and after seeing the tractography images, as well as whether tractography added value in validating their surgical approach. RESULTS In the 3 cases surveyed, 16%-44% of the surgeons changed the surgical corridor selected after seeing the tractography images. The most common finding associated with a change in surgical corridor involved intersection of the surgical corridor with visualized tracts. Consistently, >80% of the surgeons surveyed felt that tractography added value in their surgical planning. CONCLUSIONS The clinical utility of tractography in preoperative planning varies as a function of surgeon and the tumor anatomy, with >80% of the participating surgeons believing that tractography added value in preoperative surgical planning.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Pedro L Plou
- Neurosurgery Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Kevin Gunawan
- Department of Neurosurgery, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Michael Ivan
- Department of Neurosurgery, University of Miami, Miller SOM, Miami, Florida, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Prediction of the Topography of the Corticospinal Tract on T1-Weighted MR Images Using Deep-Learning-Based Segmentation. Diagnostics (Basel) 2023; 13:diagnostics13050911. [PMID: 36900055 PMCID: PMC10000710 DOI: 10.3390/diagnostics13050911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Tractography is an invaluable tool in the planning of tumor surgery in the vicinity of functionally eloquent areas of the brain as well as in the research of normal development or of various diseases. The aim of our study was to compare the performance of a deep-learning-based image segmentation for the prediction of the topography of white matter tracts on T1-weighted MR images to the performance of a manual segmentation. METHODS T1-weighted MR images of 190 healthy subjects from 6 different datasets were utilized in this study. Using deterministic diffusion tensor imaging, we first reconstructed the corticospinal tract on both sides. After training a segmentation model on 90 subjects of the PIOP2 dataset using the nnU-Net in a cloud-based environment with graphical processing unit (Google Colab), we evaluated its performance using 100 subjects from 6 different datasets. RESULTS Our algorithm created a segmentation model that predicted the topography of the corticospinal pathway on T1-weighted images in healthy subjects. The average dice score was 0.5479 (0.3513-0.7184) on the validation dataset. CONCLUSIONS Deep-learning-based segmentation could be applicable in the future to predict the location of white matter pathways in T1-weighted scans.
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Yao S, Yang R, Du C, Jiang C, Wang Y, Peng C, Bai H. Maximal safe resection of diffuse lower grade gliomas primarily within central lobe using cortical/subcortical direct electrical stimulation under awake craniotomy. Front Oncol 2023; 13:1089139. [PMID: 36895476 PMCID: PMC9990258 DOI: 10.3389/fonc.2023.1089139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/07/2023] [Indexed: 02/23/2023] Open
Abstract
Background Diffuse lower-grade glioma (DLGG) in the central lobe is a challenge for safe resection procedures. To improve the extent of resection and reduce the risk of postoperative neurological deficits, we performed an awake craniotomy with cortical-subcortical direct electrical stimulation (DES) mapping for patients with DLGG located primarily within the central lobe. We investigated the outcomes of cortical-subcortical brain mapping using DES in an awake craniotomy for central lobe DLGG resection. Methods We performed a retrospective analysis of clinical data of a cohort of consecutively treated patients from February 2017 to August 2021 with diffuse lower-grade gliomas located primarily within the central lobe. All patients underwent awake craniotomy with DES for cortical and subcortical mapping of eloquent brain areas, neuronavigation, and/or ultrasound to identify tumor location. Tumors were removed according to functional boundaries. Maximum safe tumor resection was the surgical objective for all patients. Results Thirteen patients underwent 15 awake craniotomies with intraoperative mapping of eloquent cortices and subcortical fibers using DES. Maximum safe tumor resection was achieved according to functional boundaries in all patients. The pre-operative tumor volumes ranged from 4.3 cm3 to 137.3 cm3 (median 19.2 cm3). The mean extent of tumor resection was 94.6%, with eight cases (53.3%) achieving total resection, four (26.7%) subtotal and three (20.0%) partial. The mean tumor residue was 1.2 cm3. All patients experienced early postoperative neurological deficits or worsening conditions. Three patients (20.0%) experienced late postoperative neurological deficits at the 3-month follow-up, including one moderate and two mild neurological deficits. None of the patients experienced late onset severe neurological impairments post-operatively. Ten patients with 12 tumor resections (80.0%) had resumed activities of daily living at the 3-month follow-up. Among 14 patients with pre-operative epilepsy, 12 (85.7%) were seizure-free after treatment with antiepileptic drugs 7 days after surgery up to the last follow-up. Conclusions DLGG located primarily in the central lobe deemed inoperable can be safely resected using awake craniotomy with intraoperative DES without severe permanent neurological sequelae. Patients experienced an improved quality of life in terms of seizure control.
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Affiliation(s)
- Shujing Yao
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Ruixin Yang
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Chenggang Du
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Che Jiang
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yang Wang
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Chongqi Peng
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Hongmin Bai
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
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Bykanov AE, Pitskhelauri D, Batalov AI, Trube M, Danilov G, Golbin D. Anatomical and Technical Preparations of the Human Brain for White Matter Fibers Dissection with Electromagnetic Neuronavigation Assistance Technical Nuances for Application. World Neurosurg 2022; 168:173-178. [DOI: 10.1016/j.wneu.2022.09.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
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Safri AA, Nassir CMNCM, Iman IN, Mohd Taib NH, Achuthan A, Mustapha M. Diffusion tensor imaging pipeline measures of cerebral white matter integrity: An overview of recent advances and prospects. World J Clin Cases 2022; 10:8450-8462. [PMID: 36157806 PMCID: PMC9453345 DOI: 10.12998/wjcc.v10.i24.8450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/20/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
Cerebral small vessel disease (CSVD) is a leading cause of age-related microvascular cognitive decline, resulting in significant morbidity and decreased quality of life. Despite a progress on its key pathophysiological bases and general acceptance of key terms from neuroimaging findings as observed on the magnetic resonance imaging (MRI), key questions on CSVD remain elusive. Enhanced relationships and reliable lesion studies, such as white matter tractography using diffusion-based MRI (dMRI) are necessary in order to improve the assessment of white matter architecture and connectivity in CSVD. Diffusion tensor imaging (DTI) and tractography is an application of dMRI that provides data that can be used to non-invasively appraise the brain white matter connections via fiber tracking and enable visualization of individual patient-specific white matter fiber tracts to reflect the extent of CSVD-associated white matter damage. However, due to a lack of standardization on various sets of software or image pipeline processing utilized in this technique that driven mostly from research setting, interpreting the findings remain contentious, especially to inform an improved diagnosis and/or prognosis of CSVD for routine clinical use. In this minireview, we highlight the advances in DTI pipeline processing and the prospect of this DTI metrics as potential imaging biomarker for CSVD, even for subclinical CSVD in at-risk individuals.
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Affiliation(s)
- Amanina Ahmad Safri
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
| | - Che Mohd Nasril Che Mohd Nassir
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ismail Nurul Iman
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
| | - Nur Hartini Mohd Taib
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
| | - Anusha Achuthan
- School of Computer Sciences, Universiti Sains Malaysia, 11800 USM, Penang, Malaysia
| | - Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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Refined Analysis of Chronic White Matter Changes after Traumatic Brain Injury and Repeated Sports-Related Concussions: Of Use in Targeted Rehabilitative Approaches? J Clin Med 2022; 11:jcm11020358. [PMID: 35054052 PMCID: PMC8780504 DOI: 10.3390/jcm11020358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 12/10/2022] Open
Abstract
Traumatic brain injury (TBI) or repeated sport-related concussions (rSRC) may lead to long-term memory impairment. Diffusion tensor imaging (DTI) is helpful to reveal global white matter damage but may underestimate focal abnormalities. We investigated the distribution of post-injury regional white matter changes after TBI and rSRC. Six patients with moderate/severe TBI, and 12 athletes with rSRC were included ≥6 months post-injury, and 10 (age-matched) healthy controls (HC) were analyzed. The Repeatable Battery for the Assessment of Neuropsychological Status was performed at the time of DTI. Major white matter pathways were tracked using q-space diffeomorphic reconstruction and analyzed for global and regional changes with a controlled false discovery rate. TBI patients displayed multiple classic white matter injuries compared with HC (p < 0.01). At the regional white matter analysis, the left frontal aslant tract, anterior thalamic radiation, and the genu of the corpus callosum displayed focal changes in both groups compared with HC but with different trends. Both TBI and rSRC displayed worse memory performance compared with HC (p < 0.05). While global analysis of DTI-based parameters did not reveal common abnormalities in TBI and rSRC, abnormalities to the fronto-thalamic network were observed in both groups using regional analysis of the white matter pathways. These results may be valuable to tailor individualized rehabilitative approaches for post-injury cognitive impairment in both TBI and rSRC patients.
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Lipp I, Mole JP, Subramanian L, Linden DEJ, Metzler-Baddeley C. Investigating the Anatomy and Microstructure of the Dentato-rubro-thalamic and Subthalamo-ponto-cerebellar Tracts in Parkinson's Disease. Front Neurol 2022; 13:793693. [PMID: 35401393 PMCID: PMC8987292 DOI: 10.3389/fneur.2022.793693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
Cerebellar-thalamic connections play a central role in deep brain stimulation-based treatment of tremor syndromes. Here, we used diffusion Magnetic Resonance Imaging (MRI) tractography to delineate the main cerebellar peduncles as well as two main white matter tracts that connect the cerebellum with the thalamus, the dentato-rubro-thalamic tract (DRTT) and the subthalamo-ponto-cerebellar tract (SPCT). We first developed a reconstruction protocol in young healthy adults with high-resolution diffusion imaging data and then demonstrate feasibility of transferring this protocol to clinical studies using standard diffusion MRI data from a cohort of patients with Parkinson's disease (PD) and their matched healthy controls. The tracts obtained closely corresponded to the previously described anatomical pathways and features of the DRTT and the SPCT. Second, we investigated the microstructure of these tracts with fractional anisotropy (FA), radial diffusivity (RD), and hindrance modulated orientational anisotropy (HMOA) in patients with PD and healthy controls. By reducing dimensionality of both the microstructural metrics and the investigated cerebellar and cerebellar-thalamic tracts using principal component analyses, we found global differences between patients with PD and controls, suggestive of higher fractional anisotropy, lower radial diffusivity, and higher hindrance modulated orientational anisotropy in patients. However, separate analyses for each of the tracts did not yield any significant differences. Our findings contribute to the characterization of the distinct anatomical connections between the cerebellum and the diencephalon. Microstructural differences between patients and controls in the cerebellar pathways suggest involvement of these structures in PD, complementing previous functional and diffusion imaging studies.
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Affiliation(s)
- Ilona Lipp
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom.,Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Jilu Princy Mole
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom.,Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Leena Subramanian
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom.,Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - David E J Linden
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom.,Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom.,Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom.,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Claudia Metzler-Baddeley
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom.,Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
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Wu C, Ferreira F, Fox M, Harel N, Hattangadi-Gluth J, Horn A, Jbabdi S, Kahan J, Oswal A, Sheth SA, Tie Y, Vakharia V, Zrinzo L, Akram H. Clinical applications of magnetic resonance imaging based functional and structural connectivity. Neuroimage 2021; 244:118649. [PMID: 34648960 DOI: 10.1016/j.neuroimage.2021.118649] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/24/2021] [Accepted: 10/10/2021] [Indexed: 12/23/2022] Open
Abstract
Advances in computational neuroimaging techniques have expanded the armamentarium of imaging tools available for clinical applications in clinical neuroscience. Non-invasive, in vivo brain MRI structural and functional network mapping has been used to identify therapeutic targets, define eloquent brain regions to preserve, and gain insight into pathological processes and treatments as well as prognostic biomarkers. These tools have the real potential to inform patient-specific treatment strategies. Nevertheless, a realistic appraisal of clinical utility is needed that balances the growing excitement and interest in the field with important limitations associated with these techniques. Quality of the raw data, minutiae of the processing methodology, and the statistical models applied can all impact on the results and their interpretation. A lack of standardization in data acquisition and processing has also resulted in issues with reproducibility. This limitation has had a direct impact on the reliability of these tools and ultimately, confidence in their clinical use. Advances in MRI technology and computational power as well as automation and standardization of processing methods, including machine learning approaches, may help address some of these issues and make these tools more reliable in clinical use. In this review, we will highlight the current clinical uses of MRI connectomics in the diagnosis and treatment of neurological disorders; balancing emerging applications and technologies with limitations of connectivity analytic approaches to present an encompassing and appropriate perspective.
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Affiliation(s)
- Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Third Floor, Philadelphia, PA 19107, USA; Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut Street, First Floor, Philadelphia, PA 19107, USA.
| | - Francisca Ferreira
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
| | - Michael Fox
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, Radiology, and Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Noam Harel
- Center for Magnetic Resonance Research, University of Minnesota, 2021 Sixth Street S.E., Minneapolis, MN 55455, USA.
| | - Jona Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, Center for Precision Radiation Medicine, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA 92037, USA.
| | - Andreas Horn
- Neurology Department, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Charitéplatz 1, D-10117, Berlin, Germany.
| | - Saad Jbabdi
- Wellcome Centre for Integrative Neuroimaging, Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Joshua Kahan
- Department of Neurology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
| | - Ashwini Oswal
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Mansfield Rd, Oxford OX1 3TH, UK.
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge, Ninth Floor, Houston, TX 77030, USA.
| | - Yanmei Tie
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, Radiology, and Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Vejay Vakharia
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK.
| | - Ludvic Zrinzo
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
| | - Harith Akram
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
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Phillips NS, Rao V, Kmetz L, Vela R, Medick S, Krull K, Kesler SR. Changes in Brain Functional and Effective Connectivity After Treatment for Breast Cancer and Implications for Intervention Targets. Brain Connect 2021; 12:385-397. [PMID: 34210168 PMCID: PMC9131353 DOI: 10.1089/brain.2021.0049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients with breast cancer frequently report cognitive impairment both during and after completion of therapy. Evidence suggests that cancer-related cognitive impairments are related to widespread neural network dysfunction. The default mode network (DMN) is a large conserved network that plays a critical role in integrating the functions of various neural systems. Disruption of the network may play a key role in the development of cognitive impairment. Methods: We compared neuroimaging and neurocognitive data from 43 newly diagnosed primary breast cancer patients (mean age = 48, standard deviation [SD] = 8.9 years) and 50 frequency-matched healthy female controls (mean age = 50, SD = 10 years) before treatment and 1 year after treatment completion. Functional and effective connectivity measures of the DMN were obtained using graph theory and Bayesian network analysis methods, respectively. Results: Compared with healthy females, the breast cancer group displayed higher global efficiency and path length post-treatment (p < 0.03, corrected). Breast cancer survivors showed significantly lower performance on measures of verbal memory, attention, and verbal fluency (p < 0.05) at both time points. Within the DMN, local brain network organization, as measured by edge-betweenness centralities, was significantly altered in the breast cancer group compared with controls at both time points (p < 0.0001, corrected), with several connections showing a significant group-by-time effect (p < 0.003, corrected). Effective connectivity demonstrated significantly altered patterns of neuronal coupling in patients with breast cancer (p < 0.05). Significant correlations were seen between hormone blockade therapy, radiation therapy, chemotherapy cycles, memory, and verbal fluency test and edge-betweenness centralities. Discussion: This pattern of altered network organization in the default mode is believed to result in reduced network efficiency and disrupted communication. Subregions of the DMN, the orbital prefrontal cortex and posterior memory network, appear to be at the center of this disruption and this could inform future interventions.
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Affiliation(s)
- Nicholas S Phillips
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Vikram Rao
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Lorie Kmetz
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Ruben Vela
- School of Nursing, University of Texas at Austin, Austin, Texas, USA.,Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA
| | - Sarah Medick
- School of Nursing, University of Texas at Austin, Austin, Texas, USA
| | - Kevin Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, Austin, Texas, USA.,Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, Texas, USA.,Center for Computational Oncology, Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, Texas, USA
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11
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Barber SR. New Navigation Approaches for Endoscopic Lateral Skull Base Surgery. Otolaryngol Clin North Am 2021; 54:175-187. [PMID: 33243374 DOI: 10.1016/j.otc.2020.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Image-guided navigation is well established for surgery of the brain and anterior skull base. Although navigation workstations have been used widely by neurosurgeons and rhinologists for decades, utilization in the lateral skull base (LSB) has been less due to stricter requirements for overall accuracy less than 1 mm in this region. Endoscopic approaches to the LSB facilitate minimally invasive surgeries with less morbidity, yet there are risks of injury to critical structures. With improvements in technology over the years, image-guided navigation for endoscopic LSB surgery can reduce operative time, optimize exposure for surgical corridors, and increase safety in difficult cases.
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Affiliation(s)
- Samuel R Barber
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
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12
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Luzzi S, Giotta Lucifero A, Martinelli A, Maestro MD, Savioli G, Simoncelli A, Lafe E, Preda L, Galzio R. Supratentorial high-grade gliomas: maximal safe anatomical resection guided by augmented reality high-definition fiber tractography and fluorescein. Neurosurg Focus 2021; 51:E5. [PMID: 34333470 DOI: 10.3171/2021.5.focus21185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The theoretical advantages of augmented reality (AR) with diffusion tensor imaging (DTI)-based high-definition fiber tractography (HDFT) and sodium fluorescein (F) in high-grade glioma (HGG) surgery have not been investigated in detail. In this study, the authors aimed to evaluate the safety and efficacy profiles of HDFT-F microscope-based AR cytoreductive surgery for newly diagnosed supratentorial HGGs. METHODS Data of patients with newly diagnosed supratentorial HGGs who underwent surgery using the AR HDFT-F technique were reviewed and compared with those of a cohort of patients who underwent conventional white-light surgery assisted by infrared neuronavigation. The safety and efficacy of the techniques were reported based on the postoperative Neurological Assessment in Neuro-Oncology (NANO) scores, extent of resection (EOR), and Kaplan-Meier curves, respectively. The chi-square test was conducted for categorical variables. A p value < 0.05 was considered statistically significant. RESULTS A total of 54 patients underwent surgery using the AR HDFT-F technique, and 63 underwent conventional white-light surgery assisted by infrared neuronavigation. The mean postoperative NANO scores were 3.8 ± 2 and 5.2 ± 4 in the AR HDFT-F group and control group, respectively (p < 0.05). The EOR was higher in the AR HDFT-F group (p < 0.05) than in the control group. With a mean follow-up of 12.2 months, the rate of progression-free survival (PFS) was longer in the study group (log-rank test, p = 0.006) than in the control group. Moreover, the complication rates were 9.2% and 9.5% in the study and control groups, respectively. CONCLUSIONS Overall, AR HDFT-F-assisted surgery is safe and effective in maximizing the EOR and PFS rate for patients with newly diagnosed supratentorial HGGs, and in optimizing patient functional outcomes.
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Affiliation(s)
- Sabino Luzzi
- 1Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia.,2Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Alice Giotta Lucifero
- 1Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia
| | - Andrea Martinelli
- 3Department of Science and High Technology, University of Insubria, Como
| | - Mattia Del Maestro
- 4PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia
| | - Gabriele Savioli
- 4PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia.,5Emergency Department, IRCCS Policlinico San Matteo, Pavia; and
| | - Anna Simoncelli
- 6Department of Diagnostic Radiology and Interventional Radiology and Neuroradiology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia; and
| | - Elvis Lafe
- 6Department of Diagnostic Radiology and Interventional Radiology and Neuroradiology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia; and
| | - Lorenzo Preda
- 6Department of Diagnostic Radiology and Interventional Radiology and Neuroradiology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia; and
| | - Renato Galzio
- 7Neurosurgery Unit, Maria Cecilia Hospital, Cotignola, Italy
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13
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You H, Qiao H. Intraoperative Neuromonitoring During Resection of Gliomas Involving Eloquent Areas. Front Neurol 2021; 12:658680. [PMID: 34248818 PMCID: PMC8260928 DOI: 10.3389/fneur.2021.658680] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
In the case of resection of gliomas involving eloquent areas, equal consideration should be given to maintain maximal extent of resection (EOR) and neurological protection, for which the intraoperative neuromonitoring (IONM) proves an effective and admirable approach. IONM techniques applied in clinical practice currently consist of somatosensory evoked potential (SSEP), direct electrical stimulation (DES), motor evoked potential (MEP), electromyography (EMG), and electrocorticography (ECoG). The combined use of DES and ECoG has been adopted widely. With the development of technology, more effective IONM tactics and programs would be proposed. The ultimate goal would be strengthening the localization of eloquent areas and epilepsy foci, reducing the incidence of postoperative dysfunction and epilepsy improving the life quality of patients.
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Affiliation(s)
- Hao You
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Hui Qiao
- Department of Neurophysiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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14
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Germann J, Elias GJB, Neudorfer C, Boutet A, Chow CT, Wong EHY, Parmar R, Gouveia FV, Loh A, Giacobbe P, Kim SJ, Jung HH, Bhat V, Kucharczyk W, Chang JW, Lozano AM. Potential optimization of focused ultrasound capsulotomy for obsessive compulsive disorder. Brain 2021; 144:3529-3540. [PMID: 34145884 DOI: 10.1093/brain/awab232] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/19/2021] [Accepted: 05/21/2021] [Indexed: 11/13/2022] Open
Abstract
Obsessive-compulsive disorder is a debilitating and often refractory psychiatric disorder. Magnetic resonance-guided focused ultrasound is a novel, minimally invasive neuromodulatory technique that has shown promise in treating this condition. We investigated the relationship between lesion location and long-term outcome in obsessive-compulsive disorder patients treated with focused ultrasound to discern the optimal lesion location and elucidate the efficacious network underlying symptom alleviation. Postoperative images of eleven patients who underwent focused ultrasound capsulotomy were used to correlate lesion characteristics with symptom improvement at one year follow-up. Normative resting-state functional MRI and normative diffusion MRI-based tractography analyses were used to determine the networks associated with successful lesions. Obsessive-compulsive disorder patients treated with inferior thalamic peduncle deep brain stimulation (n = 5) and lesions from the literature implicated in obsessive-compulsive disorder (n = 18) were used for external validation. Successful long-term relief of obsessive-compulsive disorder was associated with lesions that included a specific area in the dorsal anterior limb of the internal capsule. Normative resting-state functional MRI analysis showed that lesion engagement of areas 24 and 46 was significantly associated with clinical outcomes (R = 0.79, p = 0.004). The key role of areas 24 and 46 was confirmed by (1) normative diffusion MRI-based tractography analysis showing that streamlines associated with better outcome projected to these areas, (2) association of these areas with inferior thalamic peduncle deep brain stimulation patients' outcome (R = 0.83, p = 0.003); (3) the connectedness of these areas to obsessive-compulsive disorder-causing lesions, as identified using literature-based lesion network mapping. These results provide considerations for target improvement, outlining the specific area of the internal capsule critical for successful magnetic resonance-guided focused ultrasound outcome and demonstrating that discrete frontal areas are involved in symptom relief. This could help refine focused ultrasound treatment for obsessive-compulsive disorder and provide a network-based rationale for potential alternative targets.
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Affiliation(s)
- Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Clemens Neudorfer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Emily H Y Wong
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Roohie Parmar
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Flavia Venetucci Gouveia
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Peter Giacobbe
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Se Joo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Venkat Bhat
- Centre for Mental Health and Krembil Research Centre, University Health Network, Toronto, Canada
| | - Walter Kucharczyk
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
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15
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Ius T, Somma T, Baiano C, Guarracino I, Pauletto G, Nilo A, Maieron M, Palese F, Skrap M, Tomasino B. Risk Assessment by Pre-surgical Tractography in Left Hemisphere Low-Grade Gliomas. Front Neurol 2021; 12:648432. [PMID: 33679596 PMCID: PMC7928377 DOI: 10.3389/fneur.2021.648432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/25/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Tracking the white matter principal tracts is routinely typically included during the pre-surgery planning examinations and has revealed to limit functional resection of low-grade gliomas (LGGs) in eloquent areas. Objective: We examined the integrity of the Superior Longitudinal Fasciculus (SLF) and Inferior Fronto-Occipital Fasciculus (IFOF), both known to be part of the language-related network in patients with LGGs involving the temporo-insular cortex. In a comparative approach, we contrasted the main quantitative fiber tracking values in the tumoral (T) and healthy (H) hemispheres to test whether or not this ratio could discriminate amongst patients with different post-operative outcomes. Methods: Twenty-six patients with LGGs were included. We obtained quantitative fiber tracking values in the tumoral and healthy hemispheres and calculated the ratio (HIFOF–TIFOF)/HIFOF and the ratio (HSLF–TSLF)/HSLF on the number of streamlines. We analyzed how these values varied between patients with and without post-operative neurological outcomes and between patients with different post-operative Engel classes. Results: The ratio for both IFOF and SLF significantly differed between patient with and without post-operative neurological language deficits. No associations were found between white matter structural changes and post-operative seizure outcomes. Conclusions: Calculating the ratio on the number of streamlines and fractional anisotropy between the tumoral and the healthy hemispheres resulted to be a useful approach, which can prove to be useful during the pre-operative planning examination, as it gives a glimpse on the potential clinical outcomes in patients with LGGs involving the left temporo-insular cortex.
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Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Cinzia Baiano
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Ilaria Guarracino
- Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) E. Medea, Pordenone, Italy
| | - Giada Pauletto
- Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marta Maieron
- Medical Physics, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | - Miran Skrap
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Barbara Tomasino
- Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) E. Medea, Pordenone, Italy
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16
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Abdulbaki A, Kaufmann J, Galazky I, Buentjen L, Voges J. Neuromodulation of the subthalamic nucleus in Parkinson's disease: the effect of fiber tract stimulation on tremor control. Acta Neurochir (Wien) 2021; 163:185-195. [PMID: 33174115 PMCID: PMC7778622 DOI: 10.1007/s00701-020-04495-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022]
Abstract
Background Therapeutic effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson’s disease (PD) may in parts be attributed to the stimulation of white matter near the targeted structure. The dentato-rubro-thalamic (DRT) tract supposed to improve tremor control in patients with essential tremor could be one candidate structure. The aim of this study was to investigate the effect of stimulation proximity to the DRT on tremor control in PD patients treated with STN-DBS. Methods For this retrospective analysis, we included 36 consecutive patients (median age 65.5 years) treated with STN-DBS for disabling motor symptoms including tremor. Stereotactic implantation of DBS electrodes into the motor area of the STN was performed using direct MRI-based targeting and intraoperative microelectrode recording. Tremor severity was assessed preoperatively and at regular intervals postoperatively (Unified Parkinson’s Disease Rating Scale III). The DRT was visualized in 60 hemispheres after probabilistic fiber tracking (3-T MRI). The position of active electrode contacts was verified on intraoperative stereotactic X-rays and postoperative CT images after co-registration with 3D treatment planning MRI/CT images. We determined the shortest distance of active contacts to the ipsilateral DRT tracts on perpendicular view slices and correlated this value with tremor change percentage. Results Twelve patients had unilateral tremor only, and accordingly, 12 hemispheres were excluded from further imaging analysis. The remaining 60 hemispheres were associated with contralateral resting tremor. Active brain electrode contacts leading to resting tremor improvement (46 hemispheres) had a significantly shorter distance to the DRT (1.6 mm (0.9–2.1) [median (25th–75th percentiles)]) compared with contacts of non-responders (14 hemispheres, distance: 2.8 mm (2–4.6), p < 0.001). Conclusion This retrospective analysis suggests that in STN-DBS, better tremor control in PD patients correlates with the distance of active electrode contacts to the DRT. Tractography may optimize both individually DBS targeting and postoperative adjustment of stimulation parameters.
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Affiliation(s)
- Arif Abdulbaki
- Department Stereotactic Neurosurgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Jörn Kaufmann
- Department of Neurology, OvGU-Magdeburg, Magdeburg, Germany
| | - Imke Galazky
- Department of Neurology, OvGU-Magdeburg, Magdeburg, Germany
| | - Lars Buentjen
- Department Stereotactic Neurosurgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Jürgen Voges
- Department Stereotactic Neurosurgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany.
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17
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Jordan KM, Keshavan A, Caverzasi E, Osorio J, Papinutto N, Amirbekian B, Berger MS, Henry RG. Longitudinal Disconnection Tractograms to Investigate the Functional Consequences of White Matter Damage: An Automated Pipeline. J Neuroimaging 2020; 30:443-457. [PMID: 32436352 DOI: 10.1111/jon.12713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/27/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Neurosurgical resection is one of the few opportunities researchers have to image the human brain pre- and postfocal damage. A major challenge associated with brains undergoing surgical resection is that they often do not fit brain templates most image-processing methodologies are based on. Manual intervention is required to reconcile the pathology, requiring time investment and introducing reproducibility concerns, and extreme cases must be excluded. METHODS We propose an automatic longitudinal pipeline based on High Angular Resolution Diffusion Imaging acquisitions to facilitate a Pathway Lesion Symptom Mapping analysis relating focal white matter injury to functional deficits. This two-part approach includes (i) automatic segmentation of focal white matter injury from anisotropic power differences, and (ii) modeling disconnection using tractography on the single-subject level, which specifically identifies the disconnections associated with focal white matter damage. RESULTS The advantages of this approach stem from (1) objective and automatic lesion segmentation and tractogram generation, (2) objective and precise segmentation of affected tissue likely to be associated with damage to long-range white matter pathways (defined by anisotropic power), (3) good performance even in the cases of anatomical distortions by use of nonlinear tensor-based registration, which aligns images using an approach sensitive to white matter microstructure. CONCLUSIONS Mapping a system as variable and complex as the human brain requires sample sizes much larger than the current technology can support. This pipeline can be used to execute large-scale, sufficiently powered analyses by meeting the need for an automatic approach to objectively quantify white matter disconnection.
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Affiliation(s)
- Kesshi M Jordan
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Anisha Keshavan
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Eduardo Caverzasi
- Department of Neurology, University of California, San Francisco, CA
| | - Joseph Osorio
- Division of Neurosurgery, Department of Surgery, University of California, San Diego, CA
| | - Nico Papinutto
- Department of Neurology, University of California, San Francisco, CA
| | - Bagrat Amirbekian
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Mitchel S Berger
- Department of Neurosurgery, University of California, San Francisco, CA
| | - Roland G Henry
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
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18
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Kalyvas A, Koutsarnakis C, Komaitis S, Karavasilis E, Christidi F, Skandalakis GP, Liouta E, Papakonstantinou O, Kelekis N, Duffau H, Stranjalis G. Mapping the human middle longitudinal fasciculus through a focused anatomo-imaging study: shifting the paradigm of its segmentation and connectivity pattern. Brain Struct Funct 2019; 225:85-119. [PMID: 31773331 DOI: 10.1007/s00429-019-01987-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022]
Abstract
Τhe middle longitudinal fasciculus (MdLF) was initially identified in humans as a discrete subcortical pathway connecting the superior temporal gyrus (STG) to the angular gyrus (AG). Further anatomo-imaging studies, however, proposed more sophisticated but conflicting connectivity patterns and have created a vague perception on its functional anatomy. Our aim was, therefore, to investigate the ambiguous structural architecture of this tract through focused cadaveric dissections augmented by a tailored DTI protocol in healthy participants from the Human Connectome dataset. Three segments and connectivity patterns were consistently recorded: the MdLF-I, connecting the dorsolateral Temporal Pole (TP) and STG to the Superior Parietal Lobule/Precuneus, through the Heschl's gyrus; the MdLF-II, connecting the dorsolateral TP and the STG with the Parieto-occipital area through the posterior transverse gyri and the MdLF-III connecting the most anterior part of the TP to the posterior border of the occipital lobe through the AG. The lack of an established termination pattern to the AG and the fact that no significant leftward asymmetry is disclosed tend to shift the paradigm away from language function. Conversely, the theory of "where" and "what" auditory pathways, the essential relationship of the MdLF with the auditory cortex and the functional role of the cortical areas implicated in its connectivity tend to shift the paradigm towards auditory function. Allegedly, the MdLF-I and MdLF-II segments could underpin the perception of auditory representations; whereas, the MdLF-III could potentially subserve the integration of auditory and visual information.
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Affiliation(s)
- Aristotelis Kalyvas
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece. .,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece. .,Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Spyridon Komaitis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Karavasilis
- Second Department of Radiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Christidi
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios P Skandalakis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece.,Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Liouta
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece.,Hellenic Center for Neurosurgical Research, "PetrosKokkalis", Athens, Greece
| | - Olympia Papakonstantinou
- Second Department of Radiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Hugues Duffau
- Department of Neurosurgery, Montpellier University Medical Center, Gui de Chauliac Hospital, Montpellier, France
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Evangelismos Hospital, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Center for Neurosurgical Research, "PetrosKokkalis", Athens, Greece
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19
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A Preliminary Investigation Report on Using Probabilistic Fiber Tractography to Track Human Auditory Pathways. World Neurosurg 2019; 130:e1-e8. [DOI: 10.1016/j.wneu.2019.03.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 01/09/2023]
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20
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Alexopoulos G, Cikla U, El Tecle N, Kulkarni N, Pierson M, Mercier P, Kemp J, Coppens J, Mahmoud S, Sehi M, Bucholz R, Abdulrauf S. The Value of White Matter Tractography by Diffusion Tensor Imaging in Altering a Neurosurgeon's Operative Plan. World Neurosurg 2019; 132:e305-e313. [PMID: 31494311 DOI: 10.1016/j.wneu.2019.08.168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/17/2019] [Accepted: 08/22/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate if the implementation of white matter (WM) fiber tractography by diffusion tensor imaging in presurgical planning for supratentorial tumors proximal to eloquent WM tracts can alter a neurosurgeon's operative strategy. METHODS A retrospective review was conducted of patients with supratentorial brain tumors within eloquent WM tracts who underwent diffusion tensor imaging (DTI) tractography as part of their preoperative assessment. These patients were classified into 3 different DTI groups per the radiology reports: group 1, intact WM tracts; group 2, deviated and/or displaced WM bundles; and group 3, patients with an established WM injury (interrupted and/or destroyed tracts). A blinded prospective behavioral study followed, in which 4 neurosurgeons reviewed the preoperative images at 2 different times (magnetic resonance imaging without DTI, followed by a review of the DTI). They provided estimations about the DTI group of each individual eloquent WM category in every patient, and their planned surgical approach. RESULTS Fifteen patients (mean age, 58.3 years) were included in the study. The neurosurgeons provided a correct DTI group estimation in 53%, 60%, and 57% of the cases that involved motor/sensory pathway tracts, optic tracts, and language tracts, respectively. The neurosurgeons underestimated DTI group 3 in the motor category and in the optic category 75% of the time. DTI did not alter the planned surgical approach. CONCLUSIONS DTI WM tractography helped neurosurgeons to correctly identify patients with interrupted motor and optic pathway tracts so they could be more aggressive with the extent of tumor resection, despite its inability to alter the operative approach.
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Affiliation(s)
- Georgios Alexopoulos
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA.
| | - Ulas Cikla
- Department of Neurosurgery, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Najib El Tecle
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Neha Kulkarni
- School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Matthew Pierson
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Philippe Mercier
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Joanna Kemp
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Jeroen Coppens
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Shamseldeen Mahmoud
- Department of Radiology, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Mehrdad Sehi
- Department of Radiology, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Richard Bucholz
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Saleem Abdulrauf
- Department of Neurosurgery, Saint Louis University Hospital, St. Louis, Missouri, USA; School of Medicine, Saint Louis University Hospital, St. Louis, Missouri, USA
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21
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Advances in the Visualization and the Study of the Pyramidal Tract with Magnetic Resonance Tractography. J Med Syst 2019; 43:106. [PMID: 30879147 DOI: 10.1007/s10916-019-1242-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/06/2019] [Indexed: 10/27/2022]
Abstract
Over the last several years, specific radiological techniques have been used for the analysis of the central nervous system pathways. They involve a magnetic resonance sequence called diffusion tensor imaging. In order to process the data provided by this sequence it is necessary to use software that can post-process the image and render three-dimensional images of the central nervous system pathways. Thanks to this sequence it has been possible to isolate over the years many nerve pathways that cross the brain tissue, particularly those which occupy a significant space. This sequence could have a large variety of uses, such as helping with the study of brain anatomy, assisting with surgery planning, or establishing a relationship between the nerve fibers and tumoral lesions. However, there has been an increasing number of cases that report a low reliability related to the tractographic representation of this technique. Our goal with this article is to analyse a specific nerve pathway, the piramidal tract, in order to assess the coherence between the images obtained and the anatomy that is already known from the perspective of the radiological image, and to compare this tract between different patients.
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22
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Sahnoune I, Inoue T, Kesler SR, Rodgers SP, Sabek OM, Pedersen SE, Zawaski JA, Nelson KH, Ris MD, Leasure JL, Gaber MW. Exercise ameliorates neurocognitive impairments in a translational model of pediatric radiotherapy. Neuro Oncol 2019; 20:695-704. [PMID: 29121259 DOI: 10.1093/neuonc/nox197] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background While cranial radiation therapy (CRT) is an effective treatment, healthy areas surrounding irradiation sites are negatively affected. Frontal lobe functions involving attention, processing speed, and inhibition control are impaired. These deficits appear months to years after CRT and impair quality of life. Exercise has been shown to rejuvenate the brain and aid in recovery post-injury through its effects on neurogenesis and cognition. Methods We developed a juvenile rodent CRT model that reproduces neurocognitive deficits. Next, we utilized the model to test whether exercise ameliorates these deficits. Fischer rats (31 days old) were irradiated with a fractionated dose of 4 Gy × 5 days, trained and tested at 6, 9, and 12 months post-CRT using 5-choice serial reaction time task. After testing, fixed rat brains were imaged using diffusion tensor imaging and immunohistochemistry. Results CRT caused early and lasting impairments in task acquisition, accuracy, and latency to correct response, as well as causing stunting of growth and changes in brain volume and diffusion. Exercising after irradiation improved acquisition, behavioral control, and processing speed, mitigated the stunting of brain size, and increased brain fiber numbers compared with sedentary CRT values. Further, exercise partially restored global connectome organization, including assortativity and characteristic path length, and while it did not improve the specific regional connections that were lowered by CRT, it appeared to remodel these connections by increasing connectivity between alternate regional pairs. Conclusions Our data strongly suggest that exercise may be useful in combination with interventions aimed at improving cognitive outcome following pediatric CRT.
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Affiliation(s)
- Iman Sahnoune
- Department of Psychology, University of Houston, Houston, Texas
| | - Taeko Inoue
- Department of Pediatrics, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Shelli R Kesler
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Omaima M Sabek
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Steen E Pedersen
- Department of Molecular Physiology & Biophysics, Baylor College of Medicine, Houston, Texas
| | - Janice A Zawaski
- Department of Pediatrics, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Katharine H Nelson
- Department of Pediatrics, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - M Douglas Ris
- Department of Pediatrics, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.,Psychology Service, Texas Children's Hospital, Houston, Texas
| | - J Leigh Leasure
- Department of Psychology, University of Houston, Houston, Texas
| | - M Waleed Gaber
- Department of Pediatrics, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
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23
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Chen D, Li X, Zhu X, Wu L, Ma S, Yan J, Yan D. Diffusion Tensor Imaging with Fluorescein Sodium Staining in the Resection of High-Grade Gliomas in Functional Brain Areas. World Neurosurg 2019; 124:e595-e603. [PMID: 30639485 DOI: 10.1016/j.wneu.2018.12.160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/28/2018] [Accepted: 12/29/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the feasibility and clinical value of magnetic resonance diffusion tensor imaging (DTI) with fluorescein sodium staining (FLS) in the resection of high-grade glioma (HGG) in functional brain areas. METHODS Retrospective cohort study design. The data of 95 patients who underwent surgery at the First Affiliated Hospital of Zhengzhou University for HGG in functional brain areas from October 2014 to December 2017 were investigated. In the observation group, 49 patients underwent DTI preoperatively and received FLS for the removal of tumor during the operation. In the control group, 46 patients received the routine method. All patients were subjected to enhanced magnetic resonance imaging to assess the extent of tumor resection within 72 hours after operation. The changes in muscle strength and Karnofsky Performance Status Scale (KPS) scores were evaluated 1 month after surgery. RESULTS The extent of resection was significantly higher in the observation group than in the control group (83.7% vs. 45.7%, respectively; P < 0.001). The rate of muscle strength reduction after surgery was remarkably lower in the observation group than in the control group (20.4% vs. 47.8%, respectively; P = 0.005). KPS scores were higher in the observation group than in the control group (73.5% vs. 47.8%, respectively; P = 0.029). In the observation group, the sensitivity of FLS in identifying tumor tissue was 91.7% (44/48), with a specificity of 90.0% (45/50). CONCLUSIONS The application of DTI with FLS can facilitate the maximum resection of HGG in functional brain areas with minimum loss of fiber tracts, reduce the disability rate, and improve quality of postoperative life compared with traditional glioma surgery.
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Affiliation(s)
- Di Chen
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xueyuan Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xuqiang Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Lixin Wu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Siqi Ma
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Jing Yan
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Dongming Yan
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China.
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24
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Bertani GA, Bertulli L, Scola E, Di Cristofori A, Zavanone M, Triulzi F, Rampini PM, Carrabba GG. Optic Radiation Diffusion Tensor Imaging Tractography: An Alternative and Simple Technique for the Accurate Detection of Meyer's Loop. World Neurosurg 2018; 117:e42-e56. [DOI: 10.1016/j.wneu.2018.05.131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 12/11/2022]
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25
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Functional brain mapping: overview of techniques and their application to neurosurgery. Neurosurg Rev 2018; 42:639-647. [DOI: 10.1007/s10143-018-1007-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/25/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
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26
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Münnich T, Klein J, Hattingen E, Noack A, Herrmann E, Seifert V, Senft C, Forster MT. Tractography Verified by Intraoperative Magnetic Resonance Imaging and Subcortical Stimulation During Tumor Resection Near the Corticospinal Tract. Oper Neurosurg (Hagerstown) 2018; 16:197-210. [DOI: 10.1093/ons/opy062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 03/08/2018] [Indexed: 02/07/2023] Open
Abstract
Abstract
BACKGROUND
Tractography is a popular tool for visualizing the corticospinal tract (CST). However, results may be influenced by numerous variables, eg, the selection of seeding regions of interests (ROIs) or the chosen tracking algorithm.
OBJECTIVE
To compare different variable sets by correlating tractography results with intraoperative subcortical stimulation of the CST, correcting intraoperative brain shift by the use of intraoperative MRI.
METHODS
Seeding ROIs were created by means of motor cortex segmentation, functional MRI (fMRI), and navigated transcranial magnetic stimulation (nTMS). Based on these ROIs, tractography was run for each patient using a deterministic and a probabilistic algorithm. Tractographies were processed on pre- and postoperatively acquired data.
RESULTS
Using a linear mixed effects statistical model, best correlation between subcortical stimulation intensity and the distance between tractography and stimulation sites was achieved by using the segmented motor cortex as seeding ROI and applying the probabilistic algorithm on preoperatively acquired imaging sequences. Tractographies based on fMRI or nTMS results differed very little, but with enlargement of positive nTMS sites the stimulation-distance correlation of nTMS-based tractography improved.
CONCLUSION
Our results underline that the use of tractography demands for careful interpretation of its virtual results by considering all influencing variables.
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Affiliation(s)
- Timo Münnich
- Department of Neurosurgery, Goet-he University Hospital, Frankfurt am Main, Germany
| | - Jan Klein
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University Hospital, Frankfurt am Main, Germa-ny
| | - Anika Noack
- Department of Neurosurgery, Goet-he University Hospital, Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute for Biostatistics and Math-ematical Modelling, Goethe-University Hospital, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goet-he University Hospital, Frankfurt am Main, Germany
| | - Christian Senft
- Department of Neurosurgery, Goet-he University Hospital, Frankfurt am Main, Germany
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27
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Surgery of language-eloquent tumors in patients not eligible for awake surgery: the impact of a protocol based on navigated transcranial magnetic stimulation on presurgical planning and language outcome, with evidence of tumor-induced intra-hemispheric plasticity. Clin Neurol Neurosurg 2018; 168:127-139. [PMID: 29549813 DOI: 10.1016/j.clineuro.2018.03.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/28/2018] [Accepted: 03/06/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Awake surgery and intraoperative monitoring represent the gold standard for surgery of brain tumors located in the perisylvian region of the dominant hemisphere due to their ability to map and preserve the language network during surgery. Nevertheless, in some cases awake surgery is not feasible. This could increase the risk of postoperative language deficit. Navigated transcranial magnetic stimulation (nTMS) and nTMS-based DTI fiber tracking (DTI-FT) provide a preoperative mapping and reconstruction of the cortico-subcortical language network. This can be used to plan and guide the surgical strategy to preserve the language function. The objective if this study is to describe the impact of a non-invasive preoperative protocol for mapping the language network through the nTMS and nTMS-based DTI-FT in patients not eligible for awake surgery and thereby operated under general anesthesia for suspected language-eloquent brain tumors. PATIENTS AND METHODS We reviewed clinical data of patients not eligible for awake surgery and operated under general anaesthesia between 2015 and 2016. All patients underwent nTMS language cortical mapping and nTMS-based DTI-FT of subcortical language fascicles. The nTMS findings were used to plan and guide the maximal safe resection of the tumor. The impact on postoperative language outcome and the accuracy of the nTMS-based mapping in predicting language deficits were evaluated. RESULTS Twenty patients were enrolled in the study. The nTMS-based reconstruction of the language network was successful in all patients. Interestingly, we observed a significant association between tumor localization and the cortical distribution of the nTMS errors (p = 0.004), thereby suggesting an intra-hemispheric plasticity of language cortical areas, probably induced by the tumor itself. The nTMS mapping disclosed the true-eloquence of lesions in 12 (60%) of all suspected cases. In the remaining 8 cases (40%) the suspected eloquence of the lesion was disproved. The nTMS-based findings guided the planning and surgery through the visual feedback of navigation. This resulted in a slight reduction of the postoperative language performance at discharge that was completely recovered after one month from surgery. The accuracy of the nTMS-based protocol in predicting postoperative permanent deficits was significantly high, especially for false-eloquent lesions (p = 0.04; sensitivity 100%, specificity 57.14%, negative predictive value 100%, positive predicitive value 50%). CONCLUSIONS The nTMS-based preoperative mapping allows for a reliable visualization of the language network, being also able to identify an intra-hemispheric tumor-induced cortical plasticity. It allows for a customized surgical strategy that could preserve post-operative language function. This approach should be considered as a support for neurosurgeons whenever approaching patients affected by suspected language-eloquent tumors but not eligible for awake surgery.
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28
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Duffau H. Awake mapping is not an additional surgical technique but an alternative philosophy in the management of low-grade glioma patients. Neurosurg Rev 2017; 41:689-691. [PMID: 29236183 DOI: 10.1007/s10143-017-0937-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 12/06/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80, Avenue Augustin Fliche, 34295, Montpellier, France. .,Institute for Neuroscience of Montpellier, INSERM U1051, Team "Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors," Saint Eloi Hospital, Montpellier University Medical Center, Montpellier, France.
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29
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Maier-Hein KH, Neher PF, Houde JC, Côté MA, Garyfallidis E, Zhong J, Chamberland M, Yeh FC, Lin YC, Ji Q, Reddick WE, Glass JO, Chen DQ, Feng Y, Gao C, Wu Y, Ma J, He R, Li Q, Westin CF, Deslauriers-Gauthier S, González JOO, Paquette M, St-Jean S, Girard G, Rheault F, Sidhu J, Tax CMW, Guo F, Mesri HY, Dávid S, Froeling M, Heemskerk AM, Leemans A, Boré A, Pinsard B, Bedetti C, Desrosiers M, Brambati S, Doyon J, Sarica A, Vasta R, Cerasa A, Quattrone A, Yeatman J, Khan AR, Hodges W, Alexander S, Romascano D, Barakovic M, Auría A, Esteban O, Lemkaddem A, Thiran JP, Cetingul HE, Odry BL, Mailhe B, Nadar MS, Pizzagalli F, Prasad G, Villalon-Reina JE, Galvis J, Thompson PM, Requejo FDS, Laguna PL, Lacerda LM, Barrett R, Dell'Acqua F, Catani M, Petit L, Caruyer E, Daducci A, Dyrby TB, Holland-Letz T, Hilgetag CC, Stieltjes B, Descoteaux M. The challenge of mapping the human connectome based on diffusion tractography. Nat Commun 2017; 8:1349. [PMID: 29116093 PMCID: PMC5677006 DOI: 10.1038/s41467-017-01285-x] [Citation(s) in RCA: 704] [Impact Index Per Article: 100.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 09/01/2017] [Indexed: 01/14/2023] Open
Abstract
Tractography based on non-invasive diffusion imaging is central to the study of human brain connectivity. To date, the approach has not been systematically validated in ground truth studies. Based on a simulated human brain data set with ground truth tracts, we organized an open international tractography challenge, which resulted in 96 distinct submissions from 20 research groups. Here, we report the encouraging finding that most state-of-the-art algorithms produce tractograms containing 90% of the ground truth bundles (to at least some extent). However, the same tractograms contain many more invalid than valid bundles, and half of these invalid bundles occur systematically across research groups. Taken together, our results demonstrate and confirm fundamental ambiguities inherent in tract reconstruction based on orientation information alone, which need to be considered when interpreting tractography and connectivity results. Our approach provides a novel framework for estimating reliability of tractography and encourages innovation to address its current limitations. Though tractography is widely used, it has not been systematically validated. Here, authors report results from 20 groups showing that many tractography algorithms produce both valid and invalid bundles.
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Affiliation(s)
- Klaus H Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany.
| | - Peter F Neher
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany
| | - Jean-Christophe Houde
- Sherbrooke Connectivity Imaging Lab (SCIL), Université de Sherbrooke, Sherbrooke, QC J1K 0A5, QC, Canada
| | - Marc-Alexandre Côté
- Sherbrooke Connectivity Imaging Lab (SCIL), Université de Sherbrooke, Sherbrooke, QC J1K 0A5, QC, Canada
| | - Eleftherios Garyfallidis
- Sherbrooke Connectivity Imaging Lab (SCIL), Université de Sherbrooke, Sherbrooke, QC J1K 0A5, QC, Canada.,Department of Intelligent Systems Engineering, School of Informatics and Computing, Indiana University, Bloomington, IN 47408, USA
| | - Jidan Zhong
- Krembil Research Institute, University Health Network, Toronto, Canada, M5G 2C4
| | - Maxime Chamberland
- Sherbrooke Connectivity Imaging Lab (SCIL), Université de Sherbrooke, Sherbrooke, QC J1K 0A5, QC, Canada
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Ying-Chia Lin
- IMT-Institute for Advanced Studies, Lucca, 55100, Italy
| | - Qing Ji
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Wilburn E Reddick
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - John O Glass
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - David Qixiang Chen
- University of Toronto Institute of Medical Science, Toronto, Canada, M5S 1A8
| | - Yuanjing Feng
- Institute of Information Processing and Automation, Zhejiang University of Technology, Hangzhou, 310023, Zhejiang, China
| | - Chengfeng Gao
- Institute of Information Processing and Automation, Zhejiang University of Technology, Hangzhou, 310023, Zhejiang, China
| | - Ye Wu
- Institute of Information Processing and Automation, Zhejiang University of Technology, Hangzhou, 310023, Zhejiang, China
| | - Jieyan Ma
- United Imaging Healthcare Co., Shanghai, 201807, China
| | - Renjie He
- United Imaging Healthcare Co., Shanghai, 201807, China
| | - Qiang Li
- United Imaging Healthcare Co., Shanghai, 201807, China.,Shanghai Advanced Research Institute, Shanghai, 201210, China
| | - Carl-Fredrik Westin
- Laboratory of Mathematics in Imaging, Harvard Medical School, Boston, MA, 02215, USA
| | | | | | - Michael Paquette
- Sherbrooke Connectivity Imaging Lab (SCIL), Université de Sherbrooke, Sherbrooke, QC J1K 0A5, QC, Canada
| | - Samuel St-Jean
- Sherbrooke Connectivity Imaging Lab (SCIL), Université de Sherbrooke, Sherbrooke, QC J1K 0A5, QC, Canada
| | - Gabriel Girard
- Sherbrooke Connectivity Imaging Lab (SCIL), Université de Sherbrooke, Sherbrooke, QC J1K 0A5, QC, Canada
| | - François Rheault
- Sherbrooke Connectivity Imaging Lab (SCIL), Université de Sherbrooke, Sherbrooke, QC J1K 0A5, QC, Canada
| | - Jasmeen Sidhu
- Sherbrooke Connectivity Imaging Lab (SCIL), Université de Sherbrooke, Sherbrooke, QC J1K 0A5, QC, Canada
| | - Chantal M W Tax
- PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht, Utrecht, 3508, The Netherlands.,Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Fenghua Guo
- PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht, Utrecht, 3508, The Netherlands
| | - Hamed Y Mesri
- PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht, Utrecht, 3508, The Netherlands
| | - Szabolcs Dávid
- PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht, Utrecht, 3508, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, 3508, The Netherlands
| | - Anneriet M Heemskerk
- PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht, Utrecht, 3508, The Netherlands
| | - Alexander Leemans
- PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht, Utrecht, 3508, The Netherlands
| | - Arnaud Boré
- Centre de recherche institut universitaire de geriatrie de Montreal (CRIUGM), Université de Montréal, Montreal, QC, Canada, H3W 1W5
| | - Basile Pinsard
- Centre de recherche institut universitaire de geriatrie de Montreal (CRIUGM), Université de Montréal, Montreal, QC, Canada, H3W 1W5.,Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale (LIB), 75013, Paris, France
| | - Christophe Bedetti
- Centre de recherche institut universitaire de geriatrie de Montreal (CRIUGM), Université de Montréal, Montreal, QC, Canada, H3W 1W5.,Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada, H4J 1C5
| | - Matthieu Desrosiers
- Centre de recherche institut universitaire de geriatrie de Montreal (CRIUGM), Université de Montréal, Montreal, QC, Canada, H3W 1W5
| | - Simona Brambati
- Centre de recherche institut universitaire de geriatrie de Montreal (CRIUGM), Université de Montréal, Montreal, QC, Canada, H3W 1W5
| | - Julien Doyon
- Centre de recherche institut universitaire de geriatrie de Montreal (CRIUGM), Université de Montréal, Montreal, QC, Canada, H3W 1W5
| | - Alessia Sarica
- Neuroimaging Unit, Institute of Bioimaging and Molecular Physiology (IBFM), National Research Council (CNR), Policlinico Magna Graecia, Germaneto, 88100, CZ, Italy
| | - Roberta Vasta
- Neuroimaging Unit, Institute of Bioimaging and Molecular Physiology (IBFM), National Research Council (CNR), Policlinico Magna Graecia, Germaneto, 88100, CZ, Italy
| | - Antonio Cerasa
- Neuroimaging Unit, Institute of Bioimaging and Molecular Physiology (IBFM), National Research Council (CNR), Policlinico Magna Graecia, Germaneto, 88100, CZ, Italy
| | - Aldo Quattrone
- Neuroimaging Unit, Institute of Bioimaging and Molecular Physiology (IBFM), National Research Council (CNR), Policlinico Magna Graecia, Germaneto, 88100, CZ, Italy.,Institute of Neurology, University Magna Graecia, Germaneto, 88100, CZ, Italy
| | - Jason Yeatman
- Institute for Learning & Brain Sciences and Department of Speech & Hearing Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Ali R Khan
- Departments of Medical Biophysics & Medical Imaging, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St N, London, ON, Canada, N6A 5C1
| | - Wes Hodges
- Synaptive Medical Inc., MaRS Discovery District, 101 College Street, Suite 200, Toronto, ON, Canada, M5V 3B1
| | - Simon Alexander
- Synaptive Medical Inc., MaRS Discovery District, 101 College Street, Suite 200, Toronto, ON, Canada, M5V 3B1
| | - David Romascano
- Signal Processing Lab (LTS5), Ecole Polytechnique Federale de Lausanne, Lausanne, 1015, Switzerland
| | - Muhamed Barakovic
- Signal Processing Lab (LTS5), Ecole Polytechnique Federale de Lausanne, Lausanne, 1015, Switzerland
| | - Anna Auría
- Signal Processing Lab (LTS5), Ecole Polytechnique Federale de Lausanne, Lausanne, 1015, Switzerland
| | - Oscar Esteban
- Biomedical Image Technologies (BIT), ETSI Telecom., U. Politécnica de Madrid and CIBER-BBN, Madrid, 28040, Spain
| | - Alia Lemkaddem
- Signal Processing Lab (LTS5), Ecole Polytechnique Federale de Lausanne, Lausanne, 1015, Switzerland
| | - Jean-Philippe Thiran
- Signal Processing Lab (LTS5), Ecole Polytechnique Federale de Lausanne, Lausanne, 1015, Switzerland.,Department of Radiology, University Hospital Center (CHUV) and University of Lausanne (UNIL), Lausanne, 1011, Switzerland
| | - H Ertan Cetingul
- Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ, 08540, USA
| | - Benjamin L Odry
- Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ, 08540, USA
| | - Boris Mailhe
- Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ, 08540, USA
| | - Mariappan S Nadar
- Medical Imaging Technologies, Siemens Healthcare, Princeton, NJ, 08540, USA
| | - Fabrizio Pizzagalli
- Imaging Genetics Center, Stevens Neuro Imaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, 90033, USA
| | - Gautam Prasad
- Imaging Genetics Center, Stevens Neuro Imaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, 90033, USA
| | - Julio E Villalon-Reina
- Imaging Genetics Center, Stevens Neuro Imaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, 90033, USA
| | - Justin Galvis
- Imaging Genetics Center, Stevens Neuro Imaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, 90033, USA
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Neuro Imaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, 90033, USA
| | | | - Pedro Luque Laguna
- NatBrainLab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Luis Miguel Lacerda
- NatBrainLab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Rachel Barrett
- NatBrainLab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Flavio Dell'Acqua
- NatBrainLab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Marco Catani
- NatBrainLab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Laurent Petit
- Groupe d'imagerie Neurofonctionnelle-Institut des Maladies Neurodégénératives (GIN-IMN), UMR5293 CNRS, CEA, University of Bordeaux, Bordeaux, 33000, France
| | - Emmanuel Caruyer
- Centre national de la recherche scientifique (CNRS), Institute for Research in IT and Random Systems (IRISA), UMR 6074 VISAGES Project-Team, Rennes, 35042, France
| | - Alessandro Daducci
- Signal Processing Lab (LTS5), Ecole Polytechnique Federale de Lausanne, Lausanne, 1015, Switzerland.,Department of Radiology, University Hospital Center (CHUV) and University of Lausanne (UNIL), Lausanne, 1011, Switzerland
| | - Tim B Dyrby
- Danish Research Centre for Magnetic Resonance, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, 2650, Denmark.,Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, 2800, Denmark
| | - Tim Holland-Letz
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany
| | - Claus C Hilgetag
- Department of Computational Neuroscience, University Medical Center Eppendorf, Hamburg, 20246, Germany
| | - Bram Stieltjes
- University Hospital Basel, Radiology & Nuclear Medicine Clinic, Basel, 4031, Switzerland
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab (SCIL), Université de Sherbrooke, Sherbrooke, QC J1K 0A5, QC, Canada.
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30
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Zheng ZL, Morykwas MJ, Tatter S, Gordon S, McGee M, Green H, Argenta LC. Ameliorating Spinal Cord Injury in an Animal Model With Mechanical Tissue Resuscitation. Neurosurgery 2017; 78:868-76. [PMID: 26479704 DOI: 10.1227/neu.0000000000001063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) is a major worldwide cause of mortality and disability with limited treatment options. Previous research applying controlled negative pressure to traumatic brain injury in rat and swine models resulted in smaller injuries and more rapid recovery. OBJECTIVE To examine the effects of the application of a controlled vacuum (mechanical tissue resuscitation [MTR]) to SCI in a rat model under several magnitudes of vacuum. METHODS Controlled contusion SCIs were created in rats. Vacuums of -50 and -75 mm Hg were compared. Analysis included open-field locomotor performance, magnetic resonance imaging (in vivo T2, ex vivo diffusion tensor imaging and fiber tractography), and histological assessments. RESULTS MTR treatment significantly improved the locomotor recovery from a Basso, Beattie, and Bresnahan score of 7.8 ± 1.9 to 11.4 ± 1.2 and 10.7 ± 1.9 at -50- and -75-mm Hg pressures, respectively, 4 weeks after injury. Both pressures also reduced fluid accumulations > 10% by T2-imaging in SCI sites. The mean fiber number and mean fiber length were greater across injured sites after MTR treatment, especially with treatment with -50 mm Hg. Myelin volume was increased significantly by 60% in the group treated with -50 mm Hg. CONCLUSION MTR of SCI in a rat model is effective in reducing edema in the injured cord, preserving myelin survival, and improving the rate and quantity of functional recovery. ABBREVIATIONS BBB, Basso, Beattie, and BresnahanDTI, diffusion tensor imagingFA, fractional anisotropyMTR, mechanical tissue resuscitationMTR50, mechanical tissue resuscitation with 50-mm Hg subatmospheric pressureMTR75, mechanical tissue resuscitation with 75-mm Hg subatmospheric pressureROI, region of interestSCI, spinal cord injury.
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Affiliation(s)
- Zhen-Lin Zheng
- Departments of *Plastic and Reconstructive Surgery, and ‡Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina; §Department of Physiology & Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Jordan KM, Amirbekian B, Keshavan A, Henry RG. Cluster Confidence Index: A Streamline-Wise Pathway Reproducibility Metric for Diffusion-Weighted MRI Tractography. J Neuroimaging 2017; 28:64-69. [PMID: 28940825 DOI: 10.1111/jon.12467] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging tractography can be used to create models of white matter fascicles. Anatomical and pathological variability between subjects can drastically alter the tractography output, so standardizing results across a cohort is nontrivial. Furthermore, tractography methods have inherently low reproducibility due to stochasticity (for probabilistic methods) and subjective decisions, since the final fascicle model often requires a manual intervention step performed by an expert human operator to control both outliers and systematic false-positive pathways, as defined by prior knowledge of anatomy. METHODS We present an approach that computationally assigns a cluster confidence index (CCI) reflecting the reproducibility of that pathway in the context of a streamline dataset. This metric is a tractography algorithm-agnostic tool that can be applied to any dataset of streamlines. RESULTS Applications of this metric include systematic elimination of outlier streamlines using a CCI threshold and interactive filtering by CCI to facilitate manual segmentation of fascicle models. CONCLUSIONS This method is intended to replace the application of a streamline density threshold so that outliers are eliminated based on low pathway density instead of voxel-wise density.
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Affiliation(s)
- Kesshi M Jordan
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco and Berkeley, CA.,Departments of Neurology, University of California, San Francisco, CA
| | - Bagrat Amirbekian
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco and Berkeley, CA.,Departments of Neurology, University of California, San Francisco, CA
| | - Anisha Keshavan
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco and Berkeley, CA.,Departments of Neurology, University of California, San Francisco, CA
| | - Roland G Henry
- UCSF-UC Berkeley Graduate Group in Bioengineering, San Francisco and Berkeley, CA.,Departments of Neurology, University of California, San Francisco, CA.,Radiology and Biomedical Imaging, University of California, San Francisco, CA
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Rollans C, Cheema K, Georgiou GK, Cummine J. Pathways of the inferior frontal occipital fasciculus in overt speech and reading. Neuroscience 2017; 364:93-106. [PMID: 28918257 DOI: 10.1016/j.neuroscience.2017.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 01/18/2023]
Abstract
In this study, we examined the relationship between tractography-based measures of white matter integrity (ex. fractional anisotropy [FA]) from diffusion tensor imaging (DTI) and five reading-related tasks, including rapid automatized naming (RAN) of letters, digits, and objects, and reading of real words and nonwords. Twenty university students with no reported history of reading difficulties were tested on all five tasks and their performance was correlated with diffusion measures extracted through DTI tractography. A secondary analysis using whole-brain Tract-Based Spatial Statistics (TBSS) was also used to find clusters showing significant negative correlations between reaction time and FA. Results showed a significant relationship between the left inferior fronto-occipital fasciculus FA and performance on the RAN of objects task, as well as a strong relationship to nonword reading, which suggests a role for this tract in slower, non-automatic and/or resource-demanding speech tasks. There were no significant relationships between FA and the faster, more automatic speech tasks (RAN of letters and digits, and real word reading). These findings provide evidence for the role of the inferior fronto-occipital fasciculus in tasks that are highly demanding of orthography-phonology translation (e.g., nonword reading) and semantic processing (e.g., RAN object). This demonstrates the importance of the inferior fronto-occipital fasciculus in basic naming and suggests that this tract may be a sensitive predictor of rapid naming performance within the typical population. We discuss the findings in the context of current models of reading and speech production to further characterize the white matter pathways associated with basic reading processes.
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Affiliation(s)
- Claire Rollans
- Faculty of Rehabilitation Medicine, 8205 114 St, 3-48 Corbett Hall, University of Alberta, Edmonton, AB T6G 2G4, Canada.
| | - Kulpreet Cheema
- Faculty of Rehabilitation Medicine, 8205 114 St, 3-48 Corbett Hall, University of Alberta, Edmonton, AB T6G 2G4, Canada
| | - George K Georgiou
- Department of Educational Psychology, 116 St & 85 Ave, 6-102 Education North, University of Alberta, Edmonton, AB T6G 2G5, Canada.
| | - Jacqueline Cummine
- Department of Communication Sciences and Disorders, 8205 114 St, 2-70 Corbett Hall, University of Alberta, Edmonton, AB T6G 2G4, Canada; Neuroscience and Mental Health Institute, 114 St & 87 Ave, 4-142 Katz Group Centre, University of Alberta, Edmonton, AB T6 G 2E1, Canada.
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Schiffler P, Tenberge JG, Wiendl H, Meuth SG. Cortex Parcellation Associated Whole White Matter Parcellation in Individual Subjects. Front Hum Neurosci 2017; 11:352. [PMID: 28729829 PMCID: PMC5498510 DOI: 10.3389/fnhum.2017.00352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/20/2017] [Indexed: 11/13/2022] Open
Abstract
The investigation of specific white matter areas is a growing field in neurological research and is typically achieved through the use of atlases. However, the definition of anatomically based regions remains challenging for the white matter and thus hinders region-specific analysis in individual subjects. In this article, we focus on creating a whole white matter parcellation method for individual subjects where these areas can be associated to cortex regions. This is done by combining cortex parcellation and fiber tracking data. By tracking fibers out of each cortex region and labeling the fibers according to their origin, we populate a candidate image. We then derive the white matter parcellation by classifying each white matter voxel according to the distribution of labels in the corresponding voxel from the candidate image. The parcellation of the white matter with the presented method is highly reliable and is not as dependent on registration as with white matter atlases. This method allows for the parcellation of the whole white matter into individual cortex region associated areas and, therefore, associates white matter alterations to cortex regions. In addition, we compare the results from the presented method to existing atlases. The areas generated by the presented method are not as sharply defined as the areas in most existing atlases; however, they are computed directly in the DWI space of the subject and, therefore, do not suffer from distortion caused by registration. The presented approach might be a promising tool for clinical and basic research to investigate modalities or system specific micro structural alterations of white matter areas in a quantitative manner.
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Affiliation(s)
- Patrick Schiffler
- Department of Neurology, University Hospital MünsterMünster, Germany
| | - Jan-Gerd Tenberge
- Department of Neurology, University Hospital MünsterMünster, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital MünsterMünster, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital MünsterMünster, Germany
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Amirhossein JS, Arya N, Mario G, Amir S. In Reply: Evaluation of Diffusion Tensor Imaging-Based Tractography of the Corticospinal Tract: A Correlative Study With Intraoperative Magnetic Resonance Imaging and Direct Electrical Subcortical Stimulation. Neurosurgery 2017; 81:E9-E10. [DOI: 10.1093/neuros/nyx083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Liao R, Ning L, Chen Z, Rigolo L, Gong S, Pasternak O, Golby AJ, Rathi Y, O'Donnell LJ. Performance of unscented Kalman filter tractography in edema: Analysis of the two-tensor model. NEUROIMAGE-CLINICAL 2017; 15:819-831. [PMID: 28725549 PMCID: PMC5506885 DOI: 10.1016/j.nicl.2017.06.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/01/2017] [Accepted: 06/19/2017] [Indexed: 11/30/2022]
Abstract
Diffusion MRI tractography is increasingly used in pre-operative neurosurgical planning to visualize critical fiber tracts. However, a major challenge for conventional tractography, especially in patients with brain tumors, is tracing fiber tracts that are affected by vasogenic edema, which increases water content in the tissue and lowers diffusion anisotropy. One strategy for improving fiber tracking is to use a tractography method that is more sensitive than the traditional single-tensor streamline tractography. We performed experiments to assess the performance of two-tensor unscented Kalman filter (UKF) tractography in edema. UKF tractography fits a diffusion model to the data during fiber tracking, taking advantage of prior information from the previous step along the fiber. We studied UKF performance in a synthetic diffusion MRI digital phantom with simulated edema and in retrospective data from two neurosurgical patients with edema affecting the arcuate fasciculus and corticospinal tracts. We compared the performance of several tractography methods including traditional streamline, UKF single-tensor, and UKF two-tensor. To provide practical guidance on how the UKF method could be employed, we evaluated the impact of using various seed regions both inside and outside the edematous regions, as well as the impact of parameter settings on the tractography sensitivity. We quantified the sensitivity of different methods by measuring the percentage of the patient-specific fMRI activation that was reached by the tractography. We expected that diffusion anisotropy threshold parameters, as well as the inclusion of a free water model, would significantly influence the reconstruction of edematous WM fiber tracts, because edema increases water content in the tissue and lowers anisotropy. Contrary to our initial expectations, varying the fractional anisotropy threshold and including a free water model did not affect the UKF two-tensor tractography output appreciably in these two patient datasets. The most effective parameter for increasing tracking sensitivity was the generalized anisotropy (GA) threshold, which increased the length of tracked fibers when reduced to 0.075. In addition, the most effective seeding strategy was seeding in the whole brain or in a large region outside of the edema. Overall, the main contribution of this study is to provide insight into how UKF tractography can work, using a two-tensor model, to begin to address the challenge of fiber tract reconstruction in edematous regions near brain tumors. Reconstruction of edematous white matter from diffusion MRI is investigated. The performance of two–tensor unscented Kalman filter (UKF) tractography is assessed. The two–tensor model in UKF is analyzed in phantom and patient data experiments. Practical guidance on employing the UKF method in neurosurgical patients is provided
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Affiliation(s)
- Ruizhi Liao
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lipeng Ning
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zhenrui Chen
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura Rigolo
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shun Gong
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Shanghai Changzheng Hospital, Shanghai, China
| | - Ofer Pasternak
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandra J Golby
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yogesh Rathi
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Metoki A, Alm KH, Wang Y, Ngo CT, Olson IR. Never forget a name: white matter connectivity predicts person memory. Brain Struct Funct 2017. [PMID: 28646241 DOI: 10.1007/s00429-017-1458-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Through learning and practice, we can acquire numerous skills, ranging from the simple (whistling) to the complex (memorizing operettas in a foreign language). It has been proposed that complex learning requires a network of brain regions that interact with one another via white matter pathways. One candidate white matter pathway, the uncinate fasciculus (UF), has exhibited mixed results for this hypothesis: some studies have shown UF involvement across a range of memory tasks, while other studies report null results. Here, we tested the hypothesis that the UF supports associative memory processes and that this tract can be parcellated into sub-tracts that support specific types of memory. Healthy young adults performed behavioral tasks (two face-name learning tasks, one word pair memory task) and underwent a diffusion-weighted imaging scan. Our results revealed that variation in UF microstructure was significantly associated with individual differences in performance on both face-name tasks, as well as the word association memory task. A UF sub-tract, functionally defined by its connectivity between face-selective regions in the anterior temporal lobe and orbitofrontal cortex, selectively predicted face-name learning. In contrast, connectivity between the fusiform face patch and both anterior face patches had no predictive validity. These findings suggest that there is a robust and replicable relationship between the UF and associative learning and memory. Moreover, this large white matter pathway can be subdivided to reveal discrete functional profiles.
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Affiliation(s)
- Athanasia Metoki
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA.
| | - Kylie H Alm
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Yin Wang
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Chi T Ngo
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA
| | - Ingrid R Olson
- Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, USA.
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Hoefnagels FWA, de Witt Hamer PC, Pouwels PJW, Barkhof F, Vandertop WP. Impact of Gradient Number and Voxel Size on Diffusion Tensor Imaging Tractography for Resective Brain Surgery. World Neurosurg 2017. [PMID: 28624562 DOI: 10.1016/j.wneu.2017.06.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To explore quantitatively and qualitatively how the number of gradient directions (NGD) and spatial resolution (SR) affect diffusion tensor imaging (DTI) tractography in patients planned for brain tumor surgery, using routine clinical magnetic resonance imaging protocols. METHODS Of 67 patients with intracerebral lesions who had 2 different DTI scans, 3 DTI series were reconstructed to compare the effects of NGD and SR. Tractographies for 4 clinically relevant tracts (corticospinal tract, superior longitudinal fasciculus, optic radiation, and inferior fronto-occipital fasciculus) were constructed with a probabilistic tracking algorithm and automated region of interest placement and compared for 3 quantitative measurements: tract volume, median fiber density, and mean fractional anisotropy, using linear mixed-effects models. The mean tractography volume and intersubject reliability were visually compared across scanning protocols, to assess the clinical relevance of the quantitative differences. RESULTS Both NGD and SR significantly influenced tract volume, median fiber density, and mean fractional anisotropy, but not to the same extent. In particular, higher NGD increased tract volume and median fiber density. More importantly, these effects further increased when tracts were affected by disease. The effects were tract specific, but not dependent on threshold. The superior longitudinal fasciculus and inferior fronto-occipital fasciculus showed the most significant differences. Qualitative assessment showed larger tract volumes given a fixed confidence level, and better intersubject reliability for the higher NGD protocol. SR in the range we considered seemed less relevant than NGD. CONCLUSIONS This study indicates that, under time constraints of clinical imaging, a higher number of diffusion gradients is more important than spatial resolution for superior DTI probabilistic tractography in patients undergoing brain tumor surgery.
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Affiliation(s)
- Friso W A Hoefnagels
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
| | - Philip C de Witt Hamer
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Petra J W Pouwels
- Department of Physics & Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - W Peter Vandertop
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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New Directions in 3D Medical Modeling: 3D-Printing Anatomy and Functions in Neurosurgical Planning. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:1439643. [PMID: 29065569 PMCID: PMC5480056 DOI: 10.1155/2017/1439643] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/13/2017] [Indexed: 12/03/2022]
Abstract
This paper illustrates the feasibility and utility of combining cranial anatomy and brain function on the same 3D-printed model, as evidenced by a neurosurgical planning case study of a 29-year-old female patient with a low-grade frontal-lobe glioma. We herein report the rapid prototyping methodology utilized in conjunction with surgical navigation to prepare and plan a complex neurosurgery. The method introduced here combines CT and MRI images with DTI tractography, while using various image segmentation protocols to 3D model the skull base, tumor, and five eloquent fiber tracts. This 3D model is rapid-prototyped and coregistered with patient images and a reported surgical navigation system, establishing a clear link between the printed model and surgical navigation. This methodology highlights the potential for advanced neurosurgical preparation, which can begin before the patient enters the operation theatre. Moreover, the work presented here demonstrates the workflow developed at the National University Hospital of Iceland, Landspitali, focusing on the processes of anatomy segmentation, fiber tract extrapolation, MRI/CT registration, and 3D printing. Furthermore, we present a qualitative and quantitative assessment for fiber tract generation in a case study where these processes are applied in the preparation of brain tumor resection surgery.
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Nelson BG, Bassett DS, Camchong J, Bullmore ET, Lim KO. Comparison of large-scale human brain functional and anatomical networks in schizophrenia. NEUROIMAGE-CLINICAL 2017; 15:439-448. [PMID: 28616384 PMCID: PMC5459352 DOI: 10.1016/j.nicl.2017.05.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/27/2017] [Accepted: 05/13/2017] [Indexed: 01/04/2023]
Abstract
Schizophrenia is a disease with disruptions in thought, emotion, and behavior. The dysconnectivity hypothesis suggests these disruptions are due to aberrant brain connectivity. Many studies have identified connectivity differences but few have been able to unify gray and white matter findings into one model. Here we develop an extension of the Network-Based Statistic (NBS) called NBSm (Multimodal Network-based statistic) to compare functional and anatomical networks in schizophrenia. Structural, resting functional, and diffusion magnetic resonance imaging data were collected from 29 chronic patients with schizophrenia and 29 healthy controls. Images were preprocessed, and average time courses were extracted for 90 regions of interest (ROI). Functional connectivity matrices were estimated by pairwise correlations between wavelet coefficients of ROI time series. Following diffusion tractography, anatomical connectivity matrices were estimated by white matter streamline counts between each pair of ROIs. Global and regional strength were calculated for each modality. NBSm was used to find significant overlap between functional and anatomical components that distinguished health from schizophrenia. Global strength was decreased in patients in both functional and anatomical networks. Regional strength was decreased in all regions in functional networks and only one region in anatomical networks. NBSm identified a distinguishing functional component consisting of 46 nodes with 113 links (p < 0.001), a distinguishing anatomical component with 47 nodes and 50 links (p = 0.002), and a distinguishing intermodal component with 26 nodes (p < 0.001). NBSm is a powerful technique for understanding network-based group differences present in both anatomical and functional data. In light of the dysconnectivity hypothesis, these results provide compelling evidence for the presence of significant overlapping anatomical and functional disruption in people with schizophrenia. A novel method for the unified analysis of functional and anatomical networks in schizophrenia is proposed. The methodology extends existing networkbased analyses to test brain network differences across imaging modalities. A fundamental disrupted network was found in those with schizophrenia when compared to healthy, agematched controls.
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Affiliation(s)
- Brent G Nelson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, USA.
| | - Danielle S Bassett
- Department of Physics, University of California, Santa Barbara, CA 93106, USA; Sage Center for the Study of the Mind, University of California, Santa Barbara, CA 93106, USA; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jazmin Camchong
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, USA
| | - Edward T Bullmore
- Behavioural & Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK; Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK; GlaxoSmithKline R&D, Cambridge, UK
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN 55454, USA
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Schlaier JR, Beer AL, Faltermeier R, Fellner C, Steib K, Lange M, Greenlee MW, Brawanski AT, Anthofer JM. Probabilistic vs. deterministic fiber tracking and the influence of different seed regions to delineate cerebellar-thalamic fibers in deep brain stimulation. Eur J Neurosci 2017; 45:1623-1633. [PMID: 28391647 DOI: 10.1111/ejn.13575] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 04/02/2017] [Accepted: 04/03/2017] [Indexed: 12/21/2022]
Abstract
This study compared tractography approaches for identifying cerebellar-thalamic fiber bundles relevant to planning target sites for deep brain stimulation (DBS). In particular, probabilistic and deterministic tracking of the dentate-rubro-thalamic tract (DRTT) and differences between the spatial courses of the DRTT and the cerebello-thalamo-cortical (CTC) tract were compared. Six patients with movement disorders were examined by magnetic resonance imaging (MRI), including two sets of diffusion-weighted images (12 and 64 directions). Probabilistic and deterministic tractography was applied on each diffusion-weighted dataset to delineate the DRTT. Results were compared with regard to their sensitivity in revealing the DRTT and additional fiber tracts and processing time. Two sets of regions-of-interests (ROIs) guided deterministic tractography of the DRTT or the CTC, respectively. Tract distances to an atlas-based reference target were compared. Probabilistic fiber tracking with 64 orientations detected the DRTT in all twelve hemispheres. Deterministic tracking detected the DRTT in nine (12 directions) and in only two (64 directions) hemispheres. Probabilistic tracking was more sensitive in detecting additional fibers (e.g. ansa lenticularis and medial forebrain bundle) than deterministic tracking. Probabilistic tracking lasted substantially longer than deterministic. Deterministic tracking was more sensitive in detecting the CTC than the DRTT. CTC tracts were located adjacent but consistently more posterior to DRTT tracts. These results suggest that probabilistic tracking is more sensitive and robust in detecting the DRTT but harder to implement than deterministic approaches. Although sensitivity of deterministic tracking is higher for the CTC than the DRTT, targets for DBS based on these tracts likely differ.
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Affiliation(s)
- Juergen R Schlaier
- Department of Neurosurgery, Medical Center, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Anton L Beer
- Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Rupert Faltermeier
- Department of Neurosurgery, Medical Center, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Claudia Fellner
- Institute of Radiology, Medical Center, University of Regensburg, Regensburg, Germany
| | - Kathrin Steib
- Department of Neurosurgery, Medical Center, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Max Lange
- Department of Neurosurgery, Medical Center, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Mark W Greenlee
- Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Alexander T Brawanski
- Department of Neurosurgery, Medical Center, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Judith M Anthofer
- Department of Neurosurgery, Medical Center, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Jordan K, Keshavan A, Mandelli ML, Henry R. Cluster-viz: A Tractography QC Tool. RESEARCH IDEAS AND OUTCOMES 2017. [DOI: 10.3897/rio.3.e12394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Marongiu A, D'Andrea G, Raco A. 1.5-T Field Intraoperative Magnetic Resonance Imaging Improves Extent of Resection and Survival in Glioblastoma Removal. World Neurosurg 2017; 98:578-586. [DOI: 10.1016/j.wneu.2016.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022]
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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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Young RJ, Tan ET, Peck KK, Jenabi M, Karimi S, Brennan N, Rubel J, Lyo J, Shi W, Zhang Z, Prastawa M, Liu X, Sperl JI, Fatovic R, Marinelli L, Holodny AI. Comparison of compressed sensing diffusion spectrum imaging and diffusion tensor imaging in patients with intracranial masses. Magn Reson Imaging 2016; 36:24-31. [PMID: 27742434 DOI: 10.1016/j.mri.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/31/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare compressed diffusion spectrum imaging (CS-DSI) with diffusion tensor imaging (DTI) in patients with intracranial masses. We hypothesized that CS-DSI would provide superior visualization of the motor and language tracts. MATERIALS AND METHODS We retrospectively analyzed 25 consecutive patients with intracranial masses who underwent DTI and CS-DSI for preoperative planning. Directionally-encoded anisotropy maps, and streamline hand corticospinal motor tracts and arcuate fasciculus language tracts were graded according to a 3-point scale. Tract counts, anisotropy, and lengths were also calculated. Comparisons were made using exact marginal homogeneity, McNemar's and Wilcoxon signed-rank tests. RESULTS Readers preferred the CS-DSI over DTI anisotropy maps in 92% of the cases, and the CS-DSI over DTI tracts in 84%. The motor tracts were graded as excellent in 80% of cases for CS-DSI versus 52% for DTI; 58% of the motor tracts graded as acceptable in DTI were graded as excellent in CS-DSI (p=0.02). The language tracts were graded as excellent in 68% for CS-DSI versus none for DTI; 78% of the language tracts graded as acceptable by DTI were graded as excellent by CS-DSI (p<0.001). CS-DSI demonstrated smaller normalized mean differences than DTI for motor tract counts, anisotropy and language tract counts (p≤0.01). CONCLUSION CS-DSI was preferred over DTI for the evaluation of motor and language white matter tracts in patients with intracranial masses. Results suggest that CS-DSI may be more useful than DTI for preoperative planning purposes.
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Affiliation(s)
- Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center; Brain Tumor Center, Memorial Sloan Kettering Cancer Center.
| | - Ek T Tan
- Department of Diagnostics, Imaging and Biomedical Technologies, GE Global Research
| | - Kyung K Peck
- Department of Radiology, Memorial Sloan Kettering Cancer Center; Department of Medical Physics, Memorial Sloan Kettering Cancer Center
| | - Mehrnaz Jenabi
- Department of Radiology, Memorial Sloan Kettering Cancer Center
| | - Sasan Karimi
- Department of Radiology, Memorial Sloan Kettering Cancer Center; Brain Tumor Center, Memorial Sloan Kettering Cancer Center
| | - Nicole Brennan
- Department of Radiology, Memorial Sloan Kettering Cancer Center
| | - Jennifer Rubel
- Department of Radiology, Memorial Sloan Kettering Cancer Center
| | - John Lyo
- Department of Radiology, Memorial Sloan Kettering Cancer Center; Brain Tumor Center, Memorial Sloan Kettering Cancer Center
| | - Weiji Shi
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Zhigang Zhang
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Marcel Prastawa
- Department of Diagnostics, Imaging and Biomedical Technologies, GE Global Research
| | - Xiaofeng Liu
- Department of Diagnostics, Imaging and Biomedical Technologies, GE Global Research
| | - Jonathan I Sperl
- Department of Diagnostics, Imaging and Biomedical Technologies, GE Global Research
| | - Robin Fatovic
- Department of Radiology, Memorial Sloan Kettering Cancer Center
| | - Luca Marinelli
- Department of Diagnostics, Imaging and Biomedical Technologies, GE Global Research
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan Kettering Cancer Center; Brain Tumor Center, Memorial Sloan Kettering Cancer Center
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Kaye HL, Peters JM, Gersner R, Chamberland M, Sansevere A, Rotenberg A. Neurophysiological evidence of preserved connectivity in tuber tissue. EPILEPSY & BEHAVIOR CASE REPORTS 2016; 7:64-68. [PMID: 28616385 PMCID: PMC5459951 DOI: 10.1016/j.ebcr.2016.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/29/2016] [Accepted: 10/05/2016] [Indexed: 06/07/2023]
Abstract
We present a case of preserved corticospinal connectivity in a cortical tuber, in a 10 year-old boy with intractable epilepsy and tuberous sclerosis complex (TSC). The patient had multiple subcortical tubers, one of which was located in the right central sulcus. In preparation for epilepsy surgery, motor mapping, by neuronavigated transcranial magnetic stimulation (nTMS) coupled with surface electromyography (EMG) was performed to locate the primary motor cortical areas. The resulting functional motor map revealed expected corticospinal connectivity in the left precentral gyrus. Surprisingly, robust contralateral deltoid and tibialis anterior motor evoked potentials (MEPs) were also elicited with direct stimulation of the cortical tuber in the right central sulcus. MRI with diffusion tensor imaging (DTI) tractography confirmed corticospinal fibers originating in the tuber. As there are no current reports of preserved connectivity between a cortical tuber and the corticospinal tract, this case serves to highlight the functional interdigitation of tuber and eloquent cortex. Our case also illustrates the widening spectrum of neuropathological abnormality in TSC that is becoming apparent with modern MRI methodology. Finally, our finding underscores the need for further study of preserved function in tuber tissue during presurgical workup in patients with TSC.
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Affiliation(s)
- HL Kaye
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- Neuromodulation Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- The F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - JM Peters
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- The F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - R Gersner
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- Neuromodulation Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - M Chamberland
- Computational Radiology Laboratory, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- Sherbrooke Connectivity Imaging Lab, Computer Science Department, Faculty of Science, University of Sherbrooke, Sherbrooke, QC, Canada
| | - A Sansevere
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - A Rotenberg
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- Neuromodulation Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
- The F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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Christidi F, Karavasilis E, Samiotis K, Bisdas S, Papanikolaou N. Fiber tracking: A qualitative and quantitative comparison between four different software tools on the reconstruction of major white matter tracts. Eur J Radiol Open 2016; 3:153-61. [PMID: 27489869 PMCID: PMC4959946 DOI: 10.1016/j.ejro.2016.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Diffusion tensor imaging (DTI) enables in vivo reconstruction of white matter (WM) pathways. Considering the emergence of numerous models and fiber tracking techniques, we herein aimed to compare, both quantitatively and qualitatively, the fiber tracking results of four DTI software (Brainance, Philips FiberTrak, DSI Studio, NordicICE) on the reconstruction of representative WM tracts. MATERIALS AND METHODS Ten healthy participants underwent 30-directional diffusion tensor imaging on a 3T-Philips Achieva TX MR-scanner. All data were analyzed by two independent sites of experienced raters with the aforementioned software and the following WM tracts were reconstructed: corticospinal tract (CST); forceps major (Fmajor); forceps minor (Fminor); cingulum bundle (CB); superior longitudinal fasciculus (SLF); inferior fronto-occipital fasciculus (IFOF). Visual inspection of the resulted tracts and statistical analysis (inter-rater and betweensoftware agreement; paired t-test) on fractional anisotropy (FA), axial and radial diffusivity (Daxial, Dradial) were applied for qualitative and quantitative evaluation of DTI software results. RESULTS Qualitative evaluation of the extracted tracts confirmed anatomical landmarks at least for the core part of each tract, even though differences in the number of fibers extracted and the whole tract were evident, especially for the CST, Fmajor, Fminor and SLF. Descriptive values did not deviate from the expected range of values for healthy adult population. Substantial inter-rater agreement (intraclass correlation coefficient [ICC], Bland-Altman analysis) was found for all tracts (ICC; FA: 0.839-0.989, Daxial: 0.704-0.991, Dradial: 0.972-0.993). Low agreement for FA, Daxial and Dradial (ICC; Bland-Altman analysis) and significant paired t-test differences (p < 0.05) were detected regarding between-software agreement. CONCLUSIONS Qualitative comparison of four different DTI software in addition to substantial inter-rater but poor between-software agreement highlight the differences on existing fiber tracking methodologies and several particularities of each WM tract, further supporting the need for further study in both clinical and research settings.
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Affiliation(s)
- Foteini Christidi
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Efstratios Karavasilis
- 2nd Department of Radiology, University General Hospital 'Attikon', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Sotirios Bisdas
- Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, UK
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Kinoshita M, Miyashita K, Tsutsui T, Furuta T, Nakada M. Critical Neural Networks in Awake Surgery for Gliomas. Neurol Med Chir (Tokyo) 2016; 56:674-686. [PMID: 27250817 PMCID: PMC5221778 DOI: 10.2176/nmc.ra.2016-0069] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
From the embarrassing character commonly infiltrating eloquent brain regions, the surgical resection of glioma remains challenging. Owing to the recent development of in vivo visualization techniques for the human brain, white matter regions can be delineated using diffusion tensor imaging (DTI) as a routine clinical practice in neurosurgery. In confirmation of the results of DTI tractography, a direct electrical stimulation (DES) substantially influences the investigation of cortico-subcortical networks, which can be identified via specific symptoms elicited in the concerned white matter tracts (eg., the arcuate fascicle, superior longitudinal fascicles, inferior fronto-occipital fascicle, inferior longitudinal fascicle, frontal aslant tract, sensori-motor tracts, optic radiation, and so forth). During awake surgery for glioma using DES, it is important to identify the anatomo-functional structure of white matter tracts to identify the surgical boundaries of brain regions not only to achieve maximal resection of the glioma but also to maximally preserve quality of life. However, the risk exists that neurosurgeons may be misled by the inability of DTI to visualize the actual anatomy of the white matter fibers, resulting in inappropriate decisions regarding surgical boundaries. This review article provides information of the critical neuronal network that is necessary to identify and understand in awake surgery for glioma, with special references to white matter tracts and the author's experiences.
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Nakamura-Palacios EM, Lopes IBC, Souza RA, Klauss J, Batista EK, Conti CL, Moscon JA, de Souza RSM. Ventral medial prefrontal cortex (vmPFC) as a target of the dorsolateral prefrontal modulation by transcranial direct current stimulation (tDCS) in drug addiction. J Neural Transm (Vienna) 2016; 123:1179-94. [DOI: 10.1007/s00702-016-1559-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/19/2016] [Indexed: 12/25/2022]
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49
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Zhao W, Ford JC, Flashman LA, McAllister TW, Ji S. White Matter Injury Susceptibility via Fiber Strain Evaluation Using Whole-Brain Tractography. J Neurotrauma 2016; 33:1834-1847. [PMID: 26782139 DOI: 10.1089/neu.2015.4239] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Microscale brain injury studies suggest axonal elongation as a potential mechanism for diffuse axonal injury (DAI). Recent studies have begun to incorporate white matter (WM) structural anisotropy in injury analysis, with initial evidence suggesting improved injury prediction performance. In this study, we further develop a tractography-based approach to analyze fiber strains along the entire lengths of fibers from voxel- or anatomically constrained whole-brain tractography. This technique potentially extends previous element- or voxel-based methods that instead utilize WM fiber orientations averaged from typically coarse elements or voxels. Perhaps more importantly, incorporating tractography-based axonal structural information enables assessment of the overall injury risks to functionally important neural pathways and the anatomical regions they connect, which is not possible with previous methods. A DAI susceptibility index was also established to quantify voxel-wise WM local structural integrity and tract-wise damage of individual neural pathways. This "graded" injury susceptibility potentially extends the commonly employed treatment of injury as a simple binary condition. As an illustration, we evaluate the DAI susceptibilities of WM voxels and transcallosal fiber tracts in three idealized head impacts. Findings suggest the potential importance of the tractography-based approach for injury prediction. These efforts may enable future studies to correlate WM mechanical responses with neuroimaging, cognitive alteration, and concussion, and to reveal the relative vulnerabilities of neural pathways and identify the most vulnerable ones in real-world head impacts.
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Affiliation(s)
- Wei Zhao
- 1 Thayer School of Engineering, Dartmouth College , Hanover, New Hampshire
| | - James C Ford
- 2 Department of Psychiatry, Geisel School of Medicine at Dartmouth , Lebanon, New Hampshire
| | - Laura A Flashman
- 2 Department of Psychiatry, Geisel School of Medicine at Dartmouth , Lebanon, New Hampshire
| | - Thomas W McAllister
- 3 Department of Psychiatry, Indiana University School of Medicine , Indianapolis, Indiana
| | - Songbai Ji
- 1 Thayer School of Engineering, Dartmouth College , Hanover, New Hampshire.,4 Department of Surgery and of Orthopaedic Surgery, Geisel School of Medicine at Dartmouth , Lebanon, New Hampshire
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Rueckriegel SM, Linsenmann T, Kessler AF, Homola GA, Bartsch AJ, Ernestus RI, Westermaier T, Löhr M. Feasibility of the Combined Application of Navigated Probabilistic Fiber Tracking and Navigated Ultrasonography in Brain Tumor Surgery. World Neurosurg 2016; 90:306-314. [PMID: 26968447 DOI: 10.1016/j.wneu.2016.02.119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 02/28/2016] [Accepted: 02/29/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Surgical resection of intra-axial tumors is a challenging procedure because of indistinct tumor margins, infiltration, and displacement of white matter tracts surrounding the lesion. Hence, gross total tumor resection without causing new neurologic deficits is demanding, especially in tumor sites adjoining eloquent structures. Feasibility of the combination of navigated probabilistic fiber tracking to identify eloquent fiber pathways and navigated ultrasonography to control brain shift was tested. METHODS Eleven patients with lesions adjacent to eloquent white matter structures (pyramidal tract, optic radiation and arcuate fascicle) were preoperatively subjected to magnetic resonance imaging including diffusion-weighted imaging on a 3-T magnetic resonance system (Trio [Siemens, Erlangen, Germany]). Probabilistic fiber tracking was performed using the tools of the FMRIB Software Library (FSL). Results of probabilistic fiber tracking and high-resolution anatomic images were integrated into the neuronavigation system Stealth Station (Medtronic, Minneapolis, Minnesota, USA) together with the navigated ultrasonography (SonoNav [Medtronic]). RESULTS FSL-based probabilistic fiber tracking depicted the pyramidal tract, the optic radiation, and arcuate fascicle anatomically plausibly. Integration of the probabilistic fiber tracking into neuronavigation was technically feasible and allowed visualization of the reconstructed fiber pathways. Navigated ultrasonography controlled brain shift. CONCLUSIONS Integration of probabilistic fiber tracking and navigated ultrasonography into intraoperative neuronavigation facilitated anatomic orientation during glioma resection. FSL-based probabilistic fiber tracking integrated sophisticated fiber tracking algorithms, including modeling of crossing fibers. Combination with navigated ultrasonography provided a three-dimensional estimation of intraoperative brain shift and, therefore, improved the reliability of neuronavigation.
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Affiliation(s)
| | - Thomas Linsenmann
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | | | - György A Homola
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas J Bartsch
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany; Center for Radiology, Bamberg, Germany; FMRIB Centre, Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom; Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ralf-Ingo Ernestus
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Mario Löhr
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
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