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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Deterministic clinical tractography is highly accurate in the vicinity of eloquent gliomas – a study by IONM and elastic fusion based on intraoperative MRI data

Deterministische klinische Traktographie ist äußerst genau in der Nähe von eloquenten Gliomen – eine Studie mittels IONM und elastischer Fusion basierend auf intraoperativen MRT-Daten

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  • presenting/speaker Sebastian Ille - Technische Universität München, München, Deutschland
  • Axel Schröder - Technische Universität München, München, Deutschland
  • Arthur Wagner - Technische Universität München, München, Deutschland
  • Benedikt Wiestler - Technische Universität München, München, Deutschland
  • Kornelia Kreiser - Technische Universität München, München, Deutschland
  • Bernhard Meyer - Technische Universität München, München, Deutschland
  • Sandro Krieg - Technische Universität München, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP063

doi: 10.3205/20dgnc351, urn:nbn:de:0183-20dgnc3518

Published: June 26, 2020

© 2020 Ille et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Intraoperative neuromonitoring (IONM) is the gold standard technique for a safe resection of motor eloquent gliomas. To get an impression of the corticospinal tract (CST), diffusion tensor imaging fiber tracking (DTI FT) can be used. The study evaluates the correlation of IONM and DTI FT with the postoperative motor outcome by intraoperative magnetic resonance imaging (iMRI)-based elastic fusion (IBEF).

Methods: Of 154 patients with motor eloquent gliomas between July 2018 and July 2019, we performed a matched-pair analysis of five patients with (A) and without (B) an intraoperative amplitude loss of motor evoked potential (MEP) monitoring during resection, respectively. Preoperatively, we performed DTI FT of the CST in all patients. Intraoperatively, we performed an IBEF, which enables to adjust preoperative fiber objects to new conditions such as brain shift and resection cavity.

Results: The postoperative motor status correlated with the results of IONM in both groups. The mean correction of the CST by IBEF was 5.1±2.3 mm (A) vs. 5.6±3.1 mm (B) (p=.84). With a threshold of <5 mm distance between resection cavity and fiber objects, all patients of group A showed CST lesions after IBEF while no patient of group B showed lesions of the CST after IBEF. Before the application of IBEF, two patients of group A and 1 one patient of group B showed lesions of the CST.

Conclusion: Based on the visualization of subcortical pathways after IBEF, the present matched-pair analysis approves the reliability of DTI FT of the CST by its correlation to IONM and the postoperative clinical status of patients. The results prove the relevance of applying IBEF with the aim of adjusting preoperatively determined subcortical fiber objects.