gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Diffusion tensor imaging based language fiber tract navigation in glioma surgery

Meeting Abstract

  • C. Nimsky - Neurochirurgische Klinik, Klinikum der Universität Erlangen-Nürnberg
  • D. Kuhnt - Neurochirurgische Klinik, Klinikum der Universität Erlangen-Nürnberg
  • B. von Keller - Neurochirurgische Klinik, Klinikum der Universität Erlangen-Nürnberg
  • D. Weigel - Neurochirurgische Klinik, Klinikum der Universität Erlangen-Nürnberg
  • P. Grummich - Neurochirurgische Klinik, Klinikum der Universität Erlangen-Nürnberg
  • O. Ganslandt - Neurochirurgische Klinik, Klinikum der Universität Erlangen-Nürnberg
  • M. Buchfelder - Neurochirurgische Klinik, Klinikum der Universität Erlangen-Nürnberg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP02-03

DOI: 10.3205/09dgnc263, URN: urn:nbn:de:0183-09dgnc2630

Veröffentlicht: 20. Mai 2009

© 2009 Nimsky 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 prevent speech deficits in glioma surgery by integrating the course of fibers connecting language related brain areas into a microscope-based navigation setup.

Methods: Diffusion tensor imaging based fiber tracking was performed applying diffusion weighted echo planar imaging on a 1.5T MR. Broca and Wernicke areas were identified by functional MRI and used as seed regions for tracking. A tensor-deflection algorithm was applied to reconstruct language related fiber tracts, which were rigidly co-registered with 3-D anatomical data for navigation integration. Additionally, fiber tracts reconstructed applying probabilistic tracking (A*-algorithm) were used for validation. Envelopes wrapping the reconstructed fiber bundles were generated automatically and visualized in the surgical field using operating microscope head-up displays.

Results: In 36 glioma patients (WHO grade I: 2, II: 6, III: 14, IV: 14) language fiber tracts, motor, and sensory language areas were visualized successfully into the surgical field. Navigation accuracy documented as target registration error was 1.7±0.7 mm. The differences between the 3-D objects generated by both tracking strategies were less than 5 mm. The image distortion of the B0 diffusion images impeded registration for navigation integration with less than 2 mm in the areas of interest.

In 9 patients (25%) (among which were 5 with preoperative speech deficits) we observed a speech deterioration which resolved only partially in 2 (5.6%) (both had no preoperative deficits) and completely reached the preoperative status in 7 (19.4%).

Conclusions: The course of language fiber tracts can be visualized reliably within the operative field, allowing removal of gliomas adjacent to language areas with low morbidity.