gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Individual 3D fibre tract atlas of the brain stem on the basis of DWI for microneurosurgery of brain stem cavernomas

Individuelle 3D-Faserbahn-Atlanten des Hirnstammes auf Basis der DWI zur Planung der mikroneurochirurgischen Entfernung von Hirnstamm-Kavernomen

Meeting Abstract

  • corresponding author Volker Arnd Coenen - Neurochirurgische Klinik, Universitätsklinikum Aachen, Aachen
  • H. Axer - Klinik für Neurologie, Friedrich-Schiller Universität, Jena
  • J. Weidemann - Neuroradiologie, Universitätsklinikum Aachen, Aachen
  • J. M. Gilsbach - Neurochirurgische Klinik, Universitätsklinikum Aachen, Aachen
  • V. Rohde - Neurochirurgische Klinik, Universitätsklinikum Aachen, Aachen

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 08.83

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0366.shtml

Veröffentlicht: 23. April 2004

© 2004 Coenen et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective

To investigate the potential of an individual fiber tract atlas of the human brain stem on the basis of diffusion weighted imaging (DWI) compared to a histologically derived atlas in predicting large fiber tract involvement in patients with brain stem lesions during microneurosurgical removal.

Methods

Two patients (m 17 y, f 40 y) with symptomatic cavernomas of the brain stem were operated with the presented technique. Preoperatively both underwent DWI imaging and T1W high resolution 3D anatomical sequences. After fusion of both sequences, the lesions and the principle motor pathways were segmented interactively and reconstructed three-dimensionally. As a comparison, a new fibre tract atlas of the brainstem was utilized. Serial histological sections of one cadaver human brainstem were used to derive fibre orientation maps by analysis of polarized light sequences of these sections which gives information about angles of fibre inclination and angles of fibre direction. In the resulting 3D data set, major fibre tracts were segmented using the software tool 3D Slicer (Gering 1999, USA).

Results

In one patient, the cavernoma displaced the pyramidal tract anteriorly at the level of the upper pons. The histologically derived atlas was not able to predict the fiber tract position as the individual DWI derived atlas could. The lesion was removed via a lateral suboccipital retrosigmoidal approach and the clinical status remained unchanged. In the other patient the cavernoma led to an anterior and lateral displacement of the pyramidal tract at the level of the lower pons. Again, the histologically derived atlas data was not able to predict this fibre tract position. The lesion was removed through the brachium pontis preserving an unchanged neurological status.

Conclusions

The individual fiber tract atlas obtained by DWI data convey important additional information on fibre tracts’ positions during microneurosurgical removal of brain stem lesions. From our limited experience with this technique, we conclude that this individualized information is superior to normal probabilistic anatomical atlas data.