ABSTRACTdiffusion tensor imaging (DTI) technology (17), it is possible now to identify the major brain white matter fibers. However, it is still difficult to achieve imaging of the small fiber bundles such as CNs. A number of recent researches have attempted to identify CNs using high-resolution or high-density DTI in subjects with or without skull base lesions (7,20). The present study aimed to identify CNs in patients with skull base tumor using DTI technology with special parameters and analyze the technological parameters used. It also involved the evaluation of preoperative estimates and intraoperative confirmation of the relationship between nerves and tumor by verifying the accuracy of visualization. █ INTRODUCTIONA dvances in neuroimaging, intraoperative monitoring, and microsurgical technique have shifted the current focus of skull base surgery from preserving life to preserving cranial nerve function. Preoperative planning using 3-dimensional (3D) visualization of image fusion has become an important development trend in skull base surgery. However, exact visualization and identification of cranial nerves (CNs) is still a challenging task with these imaging techniques due to lack of practical technology support, especially during pathological conditions. Thanks to the rapid development of AIm: To visualize cranial nerves (CNs) using diffusion tensor imaging (DTI) with special parameters. This study also involved the evaluation of preoperative estimates and intraoperative confirmation of the relationship between nerves and tumor by verifying the accuracy of visualization. mATERIAl and mEThODS: 3T magnetic resonance imaging scans including 3D-FSPGR, FIeSTA, and DTI were used to collect information from 18 patients with skull base tumor. DTI data were integrated into the 3D slicer for fiber tracking and overlapped anatomic images to determine course of nerves. 3D reconstruction of tumors was achieved to perform neighboring, encasing, and invading relationship between lesion and nerves. RESUlTS:Optic pathway including the optic chiasm could be traced in cases of tuberculum sellae meningioma and hypophysoma (pituitary tumor). The oculomotor nerve, from the interpeduncular fossa out of the brain stem to supraorbital fissure, was clearly visible in parasellar meningioma cases. Meanwhile, cisternal parts of trigeminal nerve and abducens nerve, facial nerve were also imaged well in vestibular schwannomas and petroclival meningioma cases. The 3D-spatial relationship between CNs and skull base tumor estimated preoperatively by tumor modeling and tractography corresponded to the results determined during surgery. CONClUSION:Supported by DTI and 3D slicer, preoperative 3D reconstruction of most CNs related to skull base tumor is feasible in pathological circumstances. We consider DTI Technology to be a useful tool for predicting the course and location of most CNs, and syntopy between them and skull base tumor.
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