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

Tumour resection with fiber tracking integrated neuronavigation of the pyramidal tract: experience and results of 21 cases

Tumorresektion unter Zuhilfenahme der Neuronavigation mit fiber tracking der Pyramidenbahn: Erfahrungen und Ergebnisse in 21 Fällen

Meeting Abstract

  • corresponding author M. B. Glaser - Neurochirurgische Klinik und Poliklinik der Johannes-Gutenberg-Universität Mainz
  • S. Welschehold - Neurochirurgische Klinik und Poliklinik der Johannes-Gutenberg-Universität Mainz
  • P. Dellani - Neuroradiologisches Institut der Johannes-Gutenberg-Universität Mainz
  • A. Tropine - Neuroradiologisches Institut der Johannes-Gutenberg-Universität Mainz
  • P. Stoeter - Neuroradiologisches Institut der Johannes-Gutenberg-Universität Mainz
  • A. Perneczky - Neurochirurgische Klinik und Poliklinik der Johannes-Gutenberg-Universität Mainz

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. DocP001

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0269.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Glaser 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

Text

Objective

To investigate the clinical relevance of the visualization of the pyramidal tract constructed by diffusion tensor imaging (DTI) in neuronavigation during neurosurgical tumour removal.

Methods

With DTI it is possible to define the isotropy of protons. Along the myelin sheaths, there is a reduced isotropy. The pyramidal tract can be visualized by using ROIs along its typical course. This result can be imported into a MRI-3-D-data-set and transferred to a conventional neuronavigation system (Vector Vision®, BrainLAB and SonoWand®, Mison). Before surgery the approach can be planned. During surgery the pyramidal tract can be depicted in relation to the extent of the tumour removal. So the neurological status of 21 patients with intracranial lesions (12 females and 9 males, age range 16- 75 years, 12 gliomas, 3 meningiomas, 5 metastases, 1 tuberculoma) before and after surgery were examined. In a number of cases, intraoperative subcortical stimulation was performed (Ojemann Cortex Stimulator).

Results

In 14 patients the clinical status after surgery was unchanged or better than the preoperative state. 7 patients showed a neurological deterioration after surgery regarding strength; 3 had temporary hemiparesis with restitutio ad integrum. 3 patients recovered incompletely with good function in everyday life. One patient was primarily unchanged,but developed a severe hemiparesis on day 4 after surgery which did not resolve. The frequency of a new postoperative deficit was higher,the smaller the distance from the tumour border to the virtual fiber track was (critical distance ≤10mm, with no postoperative deficit above). Only within this distance were contralateral limb movements evoked by subcortical stimulation.

Conclusions

Integration of the DTI derived construction of the pyramidal tract is a valuable tool for planning the operative approach. Clinical and intraoperative findings seem to indicate the congruence of the virtual and anatomical site of the investigated pathways. Further studies are necessary. A limitations of this method may however be brain shift during tumour resection.