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Vanderweyen DC, Theaud G, Sidhu J, Rheault F, Sarubbo S, Descoteaux M, Fortin D. The role of diffusion tractography in refining glial tumor resection. Brain Struct Funct 2020; 225:1413-1436. [PMID: 32180019 DOI: 10.1007/s00429-020-02056-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022]
Abstract
Primary brain tumors are notoriously hard to resect surgically. Due to their infiltrative nature, finding the optimal resection boundary without damaging healthy tissue can be challenging. One potential tool to help make this decision is diffusion-weighted magnetic resonance imaging (dMRI) tractography. dMRI exploits the diffusion of water molecule along axons to generate a 3D modelization of the white matter bundles in the brain. This feature is particularly useful to visualize how a tumor affects its surrounding white matter and plan a surgical path. This paper reviews the different ways in which dMRI can be used to improve brain tumor resection, its benefits and also its limitations. We expose surgical tools that can be paired with dMRI to improve its impact on surgical outcome, such as loading the 3D tractography in the neuronavigation system and direct electrical stimulation to validate the position of the white matter bundles of interest. We also review articles validating dMRI findings using other anatomical investigation techniques, such as postmortem dissections, manganese-enhanced MRI, electrophysiological stimulations, and phantom studies with known ground truth. We will be discussing the areas of the brain where dMRI performs well and where the future challenges are. We will conclude this review with suggestions and take home messages for neurosurgeons, tractographers, and vendors for advancing the field and on how to benefit from tractography's use in clinical practice.
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Affiliation(s)
- Davy Charles Vanderweyen
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, University of Sherbrooke, 3001 12 Ave N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Guillaume Theaud
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - Jasmeen Sidhu
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - François Rheault
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - Silvio Sarubbo
- Division of Neurosurgery, Emergency Area, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, University of Sherbrooke, 2500 Boulevard Université, Sherbrooke, QC, J1K2R1, Canada
| | - David Fortin
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, University of Sherbrooke, 3001 12 Ave N, Sherbrooke, QC, J1H 5H3, Canada
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Noell S, Feigl GC, Naros G, Barking S, Tatagiba M, Ritz R. Experiences in surgery of primary malignant brain tumours in the primary sensori-motor cortex practical recommendations and results of a single institution. Clin Neurol Neurosurg 2015; 136:41-50. [PMID: 26056811 DOI: 10.1016/j.clineuro.2015.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Tumour resection in the Rolandic region is a challenge. Aim of this study is to review a series of patients malignant glioma surgery in the Rolandic region which was performed by combinations of neuronavigation, sonography, 5-aminolevulinic acid fluorescence guided (5-ALA) surgery and intraoperative electrophysiological monitoring (IOM). METHODS 29 patients suffering malignant gliomas in the motor cortex (17) and sensory cortex (12) were analyzed with respect to functional outcome and grade of resections. RESULTS Improvement of motor function was seen in 41.5% one week after surgery, 41.5% were stable, only 17% deteriorated. After three months patients had an improvement of motor function in 56%, of Karnofsky Score (KPS) 27% and sensory function was improved in 8%. Deterioration of motor function was seen in 16%, in sensory function 4% and in KPS 28% after three months. 25% showed no residual tumour in early post surgical contrast enhanced MRI. 10% had less than 2% residual tumour and 15% had 2-5% residual tumour. CONCLUSIONS Preoperative functional neuroimaging, neuronavigation for planning the surgical approach and resection margins, intraoperative sonography and 5-ALA guided surgery in combination with the application of IOM shows that functional outcome and total to subtotal resection of malignant glioma in the Rolandic region is feasible.
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Affiliation(s)
- Susan Noell
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Guenther C Feigl
- Department of Neurosurgery, Bamberg Hospital, Huger Straße 80, 96049 Bamberg, Germany
| | - Georgios Naros
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Susanne Barking
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Rainer Ritz
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; Department of Neurosurgery, Philipps University Marburg, Baldingerstraße, 35043 Marburg, Germany.
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Schenk P, Siebert T, Hiepe P, Güllmar D, Reichenbach JR, Wick C, Blickhan R, Böl M. Determination of three-dimensional muscle architectures: validation of the DTI-based fiber tractography method by manual digitization. J Anat 2013; 223:61-8. [PMID: 23678961 DOI: 10.1111/joa.12062] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2013] [Indexed: 11/29/2022] Open
Abstract
In the last decade, diffusion tensor imaging (DTI) has been used increasingly to investigate three-dimensional (3D) muscle architectures. So far there is no study that has proved the validity of this method to determine fascicle lengths and pennation angles within a whole muscle. To verify the DTI method, fascicle lengths of m. soleus as well as their pennation angles have been measured using two different methods. First, the 3D muscle architecture was analyzed in vivo applying the DTI method with subsequent deterministic fiber tractography. In a second step, the muscle architecture of the same muscle was analyzed using a standard manual digitization system (MicroScribe MLX). Comparing both methods, we found differences for the median pennation angles (P < 0.001) but not for the median fascicle lengths (P = 0.216). Despite the statistical results, we conclude that the DTI method is appropriate to determine the global fiber orientation. The difference in median pennation angles determined with both methods is only about 1.2° (median pennation angle of MicroScribe: 9.7°; DTI: 8.5°) and probably has no practical relevance for muscle simulation studies. Determining fascicle lengths requires additional restriction and further development of the DTI method.
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Affiliation(s)
- P Schenk
- Institute of Motion Science, Friedrich Schiller University, Jena, Germany.
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