gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Brainstem cavernoma surgery with the support of pre- and postoperative diffusion tensor imaging; a single center study of 23 patients

Meeting Abstract

  • N.H. Ulrich - Klinik für Neurochirurgie, Universitätsspital, Zürich, Schweiz
  • R.A. Kockro - Klinik für Neurochirurgie, Universitätsspital, Zürich, Schweiz
  • D. Bellut - Klinik für Neurochirurgie, Universitätsspital, Zürich, Schweiz
  • C. Amaxopoulou - Klinik für Neuroradiologie, Universitätsspital, Zurich, Schweiz
  • J.K. Burkhardt - Klinik für Neurochirurgie, Universitätsspital, Zürich, Schweiz
  • O. Bozinov - Klinik für Neurochirurgie, Universitätsspital, Zürich, Schweiz
  • S.S. Kollias - Klinik für Neuroradiologie, Universitätsspital, Zurich, Schweiz
  • J. Sarnthein - Klinik für Neurochirurgie, Universitätsspital, Zürich, Schweiz
  • H. Bertalanffy - International Neuroscience Institute (INI), Hannover, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.14.01

DOI: 10.3205/12dgnc289, URN: urn:nbn:de:0183-12dgnc2892

Published: June 4, 2012

© 2012 Ulrich et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: The spatial complexity of highly vulnerable structures makes surgical resection of brainstem cavernomas (BSC) a challenging procedure. Diffusion tensor imaging (DTI) allows visualization of white matter tracts and enables a better understanding of the anatomical location of corticospinal and sensory tracts before and after surgery. We investigated the feasibility and clinical usefulness of DTI based fiber-tractography in patients with BSC. We assessed the accuracy of fiber visualization, its correlation with clinical outcome and its value for planning the surgical approach.

Methods: Pre- and postoperative DTI visualization of corticospinal and sensory tracts were retrospectively analyzed in 22 individuals with BSC. Preoperative and postoperative DTI-fiber accuracy was correlated with neurological findings.

Results: Preoperatively, DTI was available in 20 out of 22 patients. Corticospinal tracts were visualized in 90% of the cases. The sensory tracts could be visualized in 82% of the cases. Postoperatively, DTI was available in 14 out of 22 cases. The corticospinal tracts were visualized in 93% of the cases. Sensory tracts could be visualized in 79% of the cases. In each case the BSC has caused displacement, thinning or interruption of the fiber tracts to various degrees. Tract visualization correlated well with the pre- and postoperative neurological findings. There was no surgical damage of corticospinal tracts detectable on postoperative DTI-imaging. In one patient the sensory tracts were lost postoperatively.

Conclusions: This study confirms that DTI-tractography allows accurate and detailed white matter tract visualization not only in the supratentorial area but also in the brainstem, even when this structure is affected by an intraaxial lesion. There is a clear correlation between the appearance of the tracts and the patients' neurological status. Furthermore, visualizing the tracts adjacent to the lesion adds to our understanding of the distorted intrinsic brainstem anatomy and furnishes valuable information for planning the surgical approach.