Accuracy of Diffusion Tensor Magnetic Resonance Imaging-Based Tractography for Surgery of Gliomas Near the Pyramidal Tract

Ohue, Shiro; Kohno, Shohei; Inoue, Akihiro; Yamashita, Daisuke; Harada, Hironobu; Kumon, Yoshiaki; Kikuchi, Keiichi; Miki, Hitoshi; Ohnishi, Takanori

doi:10.1227/neu.0b013e31823020e6

Cited by 126 publications

(86 citation statements)

References 47 publications

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“…Использова-ние данных предоперационной ДТ-трактографии с интеграцией их в нейронавигационную систему по-зволяет во время резекции опухоли визуализировать расстояние от тракта до инструмента. Однако при этом могут возникать неточности из-за смещения мозговых структур [7,23]. В связи с этим прямая ЭС остается основным методом выбора для оценки ло-кализации ПТ в хирургии внутримозговых опухо-лей.…”

Section: Discussionunclassified

“…При маленькой силе тока (1-3 мА) при прямой субкортикальной ЭС только у 23 из 67 пациентов не отмечалось перма-нентных неврологических нарушений в послеопе-рационном периоде, что связано с большим объ-емом резекции у данной категории пациентов [39]. Как известно, сила тока имеет прямую взаимозави-симость с расстоянием, на которое он распростра-няется, с примерным соотношением 1 мм -1 мА («золотое правило» нейрофизиологии) [23,[40][41][42].…”

Section: Discussionunclassified

“…Таким образом, сохранность амплитуды ТК МВП во время опера-ции является надежным предиктором отсутствия нарастания и двигательного дефицита после опера-ции, что соответствует данным S. Ohue и соавт. [23].…”

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Diffusion tensor imaging tractography and intraoperative neurophysiological monitoring in surgery of intracranial tumors located near the pyramidal tract

et al. 2016

Vopr. neirokhir.

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Diffusion tensor imaging tractography and intraoperative neurophysiological monitoring in surgery of intracranial tumors located near the pyramidal tract

et al. 2016

Vopr. neirokhir.

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“…We start with an initial stimulation intensity of 10-15 mA, which corresponds to about 10-15 mm from the CST. 16,27,28,30,38 The instant an MEP is elicited, the surgeon is immediately alerted by the change of the high-pitch negative control sound to a low-pitch alert sound. The stimulation intensity is then reduced in 2-mA steps, allowing the surgeon to continue tumor removal until another low-pitch alert sound indicates that resection is getting closer to the CST.…”

Section: Intraoperative Handling Of the Continuous Dynamic Mapping Dementioning

confidence: 99%

“…16,19,27 As a rule of thumb, 1 mA of current corresponds to 1 mm remaining distance to the CST. 27,28 We previously demonstrated a safe window between high and low MTs for mechanical injury to the CST and showed that significant signal changes in MEP monitoring and permanent motor deficits do not occur above very low MTs of less than 1-2 mA. 38 These data also support the hypothesis that insufficient spatial and temporal coverage of the surgical site due to use of an interruptive and punctiform mapping technique may contribute to motor deficits despite higher and apparently safe MTs (3-6 mA).…”

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Intraoperative monopolar mapping during 5-ALA–guided resections of glioblastomas adjacent to motor eloquent areas: evaluation of resection rates and neurological outcome

Schucht¹,

Seidel²,

Beck³

et al. 2014

FOC

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Object Resection of glioblastoma adjacent to motor cortex or subcortical motor pathways carries a high risk of both incomplete resection and postoperative motor deficits. Although the strategy of maximum safe resection is widely accepted, the rates of complete resection of enhancing tumor (CRET) and the exact causes for motor deficits (mechanical vs vascular) are not always known. The authors report the results of their concept of combining monopolar mapping and 5-aminolevulinic acid (5-ALA)–guided surgery in patients with glioblastoma adjacent to eloquent tissue. Methods The authors prospectively studied 72 consecutive patients who underwent 5-ALA–guided surgery for a glioblastoma adjacent to the corticospinal tract (CST; < 10 mm) with continuous dynamic monopolar motor mapping (short-train interstimulus interval 4.0 msec, pulse duration 500 μsec) coupled to an acoustic motor evoked potential (MEP) alarm. The extent of resection was determined based on early (< 48 hours) postoperative MRI findings. Motor function was assessed 1 day after surgery, at discharge, and at 3 months. Results Five patients were excluded because of nonadherence to protocol; thus, 67 patients were evaluated. The lowest motor threshold reached during individual surgery was as follows (motor threshold, number of patients): > 20 mA, n = 8; 11–20 mA, n = 13; 6–10 mA, n = 10; 4–5 mA, n = 13; and 1–3 mA, n = 23. Motor deterioration at postsurgical Day 1 and at discharge occurred in 30% (n = 20) and 10% (n = 7) of patients, respectively. At 3 months, 3 patients (4%) had a persisting postoperative motor deficit, 2 caused by vascular injury and 1 by mechanical injury. The rates of intra- and postoperative seizures were 1% and 0%, respectively. Complete resection of enhancing tumor was achieved in 73% of patients (49/67) despite proximity to the CST. Conclusions A rather high rate of CRET can be achieved in glioblastomas in motor eloquent areas via a combination of 5-ALA for tumor identification and intraoperative mapping for distinguishing between presumed and actual motor eloquent tissues. Continuous dynamic mapping was found to be a very ergonomic technique that localizes the motor tissue early and reliably.

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MRI in the evaluation of localization‐related epilepsy

Martínez-Ríos

McAndrews

Logan

et al. 2016

Magnetic Resonance Imaging

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This article covers the MRI evaluation of patients with epilepsy, with a focus on neuroimaging in those with localization-related epilepsy who may be potential epilepsy surgery candidates. The article includes structural MRI to identify a lesion, functional MRI to identify the eloquent cortex and diffusion tensor imaging to identify the eloquent white matter tracts. We consider the equipment, protocol or procedures, and reporting of MRI in patients with epilepsy. Recommendations for both adult and pediatric patients are described for protocols and procedures. The authors hope that this article will provide a standardized approach for clinical imaging of patients with suspected localization-related epilepsy who may be evaluated for epilepsy surgery. J. Magn. Reson. Imaging 2016.

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Accuracy of Diffusion Tensor Magnetic Resonance Imaging-Based Tractography for Surgery of Gliomas Near the Pyramidal Tract

Abstract: DT imaging-based fiber tracking is a reliable and accurate method for mapping the course of subcortical PTs. Fiber tracking and intraoperative MEPs were useful for preserving motor function in patients with gliomas near the PT.

Cited by 126 publications

References 47 publications

Diffusion tensor imaging tractography and intraoperative neurophysiological monitoring in surgery of intracranial tumors located near the pyramidal tract

Diffusion tensor imaging tractography and intraoperative neurophysiological monitoring in surgery of intracranial tumors located near the pyramidal tract

Intraoperative monopolar mapping during 5-ALA–guided resections of glioblastomas adjacent to motor eloquent areas: evaluation of resection rates and neurological outcome

MRI in the evaluation of localization‐related epilepsy

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