Combined use of tractography-integrated functional neuronavigation and direct fiber stimulation.

OBJECT The aim of this study was better preoperative planning and direct application to intraoperative procedures through accurate coregistration of diffusion-tensor (DT) imaging-based tractography results and anatomical three-dimensional magnetic resonance images and subsequent importation of the combined images to a neuronavigation system (functional neuronavigation). METHODS Six patients with brain lesions adjacent to the corticospinal tract (CST) were studied. During surgery, direct fiber stimulation was used to evoke motor responses to confirm the accuracy of CST depicted on functional neuronavigation. In three patients, stimulation of the supposed CST elicited the expected motor evoked potentials. In the other three, stimulation at the resection borders more than 1 cm away from the supposed CST showed no motor response. All patients underwent appropriate tumor resection with preservation of the CST. CONCLUSIONS Integration of the DT imaging-based tractography information into a traditional neuronavigation system demonstrated spatial relationships between lesions and the CST, allowing for the avoidance of tract injury during lesion resection. Direct fiber stimulation was used for real-time reliable white matter mapping, which served to adjust for any discrepancy between the neuronavigation system data and potentially shifted positions of the brain structures. The combination of these techniques enabled the authors to identify accurate positions of the CST during surgery and to accomplish optimal tumor resections.

[1]  Veit Rohde,et al.  Intraoperative three-dimensional visualization of the pyramidal tract in a neuronavigation system (PTV) reliably predicts true position of principal motor pathways. , 2003, Surgical neurology.

[2]  L. Lemieux,et al.  Diffusion tensor imaging demonstrates deviation of fibres in normal appearing white matter adjacent to a brain tumour , 2000, Journal of neurology, neurosurgery, and psychiatry.

[3]  P. Strick,et al.  Cerebellar connections with the motor cortex and the arcuate premotor area: An analysis employing retrograde transneuronal transport of WGA‐HRP , 1989, The Journal of comparative neurology.

[4]  M. Kraut,et al.  Comparison of weakness progression in inclusion body myositis during treatment with methotrexate or placebo , 2002, Annals of neurology.

[5]  R. Lemon,et al.  Differences in the corticospinal projection from primary motor cortex and supplementary motor area to macaque upper limb motoneurons: an anatomical and electrophysiological study. , 2002, Cerebral cortex.

[6]  Y. Masutani,et al.  Three-dimensional white matter tractography by diffusion tensor imaging in ischaemic stroke involving the corticospinal tract , 2003, Neuroradiology.

[7]  Susumu Mori,et al.  Fiber tracking: principles and strategies – a technical review , 2002, NMR in biomedicine.

[8]  P. Boesiger,et al.  SENSE‐DTI at 3 T , 2004, Magnetic resonance in medicine.

[9]  Pratik Mukherjee,et al.  Diffusion-tensor imaging-guided tracking of fibers of the pyramidal tract combined with intraoperative cortical stimulation mapping in patients with gliomas. , 2004, Journal of neurosurgery.

[10]  T. Yoshimoto,et al.  Diffusion-weighted magnetic resonance imaging in the early evaluation of corticospinal tract injury to predict functional motor outcome in patients with deep intracerebral hemorrhage. , 2000, Journal of neurosurgery.

[11]  Manuel Lopes,et al.  Intraoperative mapping of the subcortical language pathways using direct stimulations. An anatomo-functional study. , 2002, Brain : a journal of neurology.

[12]  Yoshitaka Masutani,et al.  EPI distortion correction for MR-DTI by using texture memory on graphics hardware , 2003, CARS.

[13]  Pramod K. Varshney,et al.  Mutual information-based CT-MR brain image registration using generalized partial volume joint histogram estimation , 2003, IEEE Transactions on Medical Imaging.

[14]  Raymond Sawaya,et al.  Optimizing outcomes with maximal surgical resection of malignant gliomas. , 2003, Cancer control : journal of the Moffitt Cancer Center.

[15]  M. Raichle,et al.  Tracking neuronal fiber pathways in the living human brain. , 1999, Proceedings of the National Academy of Sciences of the United States of America.

[16]  Shinya Kuriki,et al.  Visualization of the eloquent motor system by integration of MEG, functional, and anisotropic diffusion-weighted MRI in functional neuronavigation. , 2003, Surgical neurology.

[17]  O. Abe,et al.  MR diffusion tensor imaging: recent advance and new techniques for diffusion tensor visualization. , 2003, European journal of radiology.

[18]  P. Basser,et al.  MR diffusion tensor spectroscopy and imaging. , 1994, Biophysical journal.