gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

MR-spectroscopy and Perfusion-MRI: new possibilities in image supported stereotaxic neurosurgery in patients with diffuse brain lesions

MR-Spektroskopie und Perfusions-MR: neue Möglichkeiten der bildgestützten stereotaktischen Neurochirurgie bei Patienten mit diffusen Hirnläsionen

Meeting Abstract

  • corresponding author D. Winkler - Department of Neurosurgery, University of Leipzig, Germany
  • G. Peters - Department of Neurosurgery, University of Leipzig, Germany
  • A. Förschler - Department of Diagnostic Radiology, University of Leipzig, Germany
  • G. Strauss - Department of ENT, University of Leipzig, Germany
  • R. Schober - Department of Neuropathology, University of Leipzig, Germany
  • C. Zimmer - Department of Diagnostic Radiology, University of Leipzig, Germany
  • J. Meixensberger - Department of Neurosurgery, University of Leipzig, Germany

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc11.05.-16.02

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Veröffentlicht: 4. Mai 2005

© 2005 Winkler et al.
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In patients with diffuse respectively no representative changes in the common neuroradiological examination it´s difficult to determine the virtual target point for the following biopsy. In these cases MR-spectroscopy and perfusion-MR, which monitored the distribution of metabolites and the tissue perfusion selectively within the brain are useful tools for definition the target coordinates.


12 consecutive patients (six female, six male; 53,3 years mean age) with diffuse space-occupying intracerebral lesions were evaluated and operated via frame based stereotaxy using routine image series (T1w-, T2w-MR), MR-spectroscopy and perfusion-MR. In all cases the acquisition of routine image series was associated with the visualization of diffuse lesioned brain changes without detecting representative tumor foci. For stereotaxy the meaningful image fusion of MR and MR-spectroscopy (three patients), MR (T1w, T2w) and perfusion-MR (one patient) as well as MR (T1w, T2w), MR-spectroscopy and perfusion-MR (eight patients) was used.


In the result of multimodality target point coordinates could be defined in 12/12 patients. In the majority of all patients with diffuse tumor lesions, diagnosed by conventional MRI MR-spectroscopy delivered the most useful additional informations for target definition. Eleven biopsy maneuvres yielded diagnostic tissue and were classified : astrocytoma (WHO II) in two patients and one case each of oligoastrocytoma (WHO II and III), glioblastoma and toxoplasmosis. In two patients the diagnosis anaplastic astrocytoma (WHO III) and in three patients the diagnosis CNS-Lymphoma could be defined. No neuropathological diagnosis could be verified in one case.


Despite of the time and cost consuming procedure, image supported stereotaxic neurosurgery implicates the possibility to localize the intracranial pathological changes and to define the target and entry coordinates. It is our conclusion that image guided surgery allows a precise localization of the tumor lesion and an exact preoperative planning of stereotaxic biopsy. Integration of MR-spectroscopy and perfusion-MR are useful tools to increase the reliability and precission in stereotaxic procedures.