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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

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Combined use of DTI-FT and intraoperative subcortical mapping for the surgical removal of gliomas

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  • corresponding author G.A. Bertani - Neurosurgery, Dept of Neurological Sciences, University of Milano, and Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano
  • L. Bello - Neurosurgery, Dept of Neurological Sciences, University of Milano, and Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano
  • A. Castellano - Neuroradiology and CERMAC, San Raffaele Scientic Institute, Milano
  • A. Casarotti - Neurosurgery, Dept of Neurological Sciences, University of Milano, and Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano
  • S. M. Gaini - Neurosurgery, Dept of Neurological Sciences, University of Milano, and Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano
  • A. Falini - Neuroradiology and CERMAC, San Raffaele Scientic Institute, Milano

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocSO.01.01

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc001.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Bertani 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 vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.

Gliederung

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Objective: To determine the uselfulness of the combined use of motor and language tract DTI FT and intraoperative subcortical mapping for surgical removal of gliomas.

Methods: 110 patients with gliomas (90 low and 20 high grade) were submitted to surgery with the aid of motor and language mapping (ISM). DTI-FT data for CST, IFO, SLF, UNC were available at the time surgery. DTI-FT was acquired by a 3-T MR scanner with a single-shot EPI sequence (TR/TE 8986/80 msec, b=1000 s/mm) with gradients applied along 32 non collinear directions. Data were transferred to the neuronavigational system. Functional subcortical sites identified during subcortical mapping were correlated with fiber tracts depicted by DTI-FT. The impact of the combined use of DTI FT and subcortical mapping on duration and modalities of surgical procedures, and on functional outcome of the patients was also evaluated.

Results: In high grade gliomas DTI-FT depicted tracts mostly at the border of the tumor, in low grade gliomas the fibers were frequently located inside the tumor mass. There was a high correlation between DTI-FT and ISM (sensitivity for CST=95%, language tracts=97%). For a proper reconstruction of the tracts, it was necessary to use a low FA threshold for the fiber tracking algorythm and to position additional regions of interest (ROIs). The combination of DTI-FT and ISM decreased the duration of surgery, patient fatigue and intraoperative seizures.

Conclusions: Our data indicate a good agreement between DTI-FT data and those obtained during subcortical mapping. When used in combination with subcortical mapping, DTI-FT offers the opportunity to quickly find the fibers associated with motor or language functions during surgery. The clinical relevance of this combined approach comes from the fact that it further enhances surgical safety maintaining a high rate of functional preservation.