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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Surgery of lesions lying within or adjacent to the pyramidal tract using preoperative diffusion tensor imaging and FMRI and neuronavigation

Operation in und an der Pyramidenbahn mittels prechirurgischem Diffusionstensorimaging und Neuronavigation

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Peter Grummich - Universität Erlangen/Nürnberg, Neurochirurgische Klinik, Erlangen, Deutschland
  • Michael Buchfelder - Universität Erlangen/Nürnberg, Neurochirurgische Klinik, Erlangen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV229

doi: 10.3205/21dgnc220, urn:nbn:de:0183-21dgnc2206

Veröffentlicht: 4. Juni 2021

© 2021 Grummich et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Surgery within or close to the pyramidal tract demands special attention to avoid permanent plegia. To maximize the extent of resection during surgery within or adjacent to this area, a detailed functional mapping of these areas is necessary.

Methods: DTI was used with 1.9 mm slices and 12 directions to reconstruct the pyramidal tract. Intraoperative MRI was used and registered to the functional images to show the extent of resection, the brain shift and an update of the relation to functional structures.

fMRI was used to show the starting area for the pyramidal tract with a 1.5T MR scanner with echo planar imaging (Sonata, Siemens Medical Solutions) and a block paradigm with 120 measurements in 6 blocks (rest alternating with activation, 16 slices, 3mm thickness & resolution TR=1580, TE=60). During the activation intervals patients had to perform movements.

Results: The Pyramidal tract was reconstructed in 470 patients. Surgery in various parts of the pyramidal tracts were accomplished: 1 within the pons (cavernoma), 3 within basal nuclei (2 cavernoma and 1 glioma), the others within the white matter of the telencephalon. There was no worsening of movement abilities of all patients observed due to an injury of the pyramidal tract. Only one patient suffered from an worsening of movement abilities due to an media infarction.

Conclusion: Resection close and even within the pyramidal tract is possible without permanent movement deficit. This demands a detailed reconstruction for the pyramidal tract to several motor areas and an ongoing update of navigation.

Figure 1 [Fig. 1]