Inferior Fronto-Occipital fascicle anatomy in brain tumor surgeries: From anatomy lab to surgical theater

Altieri, Roberto; Melcarne, Antonio; Jünemann, C; Zeppa, Pietro; Zenga, Francesco; Garbossa, Diego; Certo, Francesco; Barbagallo, Giuseppe

doi:10.1016/j.jocn.2019.07.039

Cited by 26 publications

(19 citation statements)

References 18 publications

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“…Reproducible results from the CC were expected due to its large size and unambiguous location of the CC proper, while the CST is arguably one of the most well-studied tracts. The IFOF, while one of the more controversial fasciculi [15][16][17][18], likely results in higher overlap because it is a long anterior-posterior directed pathway spanning from the occipital to frontal lobe, passing through the temporal stem, a tight and small bottleneck region [19] and most protocols agree that nearly any streamline spanning this extent through a ventral route, will belong to this pathway. In all cases, the overlap across protocols is fairly low, with median values of the CC of 0.66 and 0.72 being the highest among all pathways studied.…”

Section: Inter-protocol Variabilitymentioning

confidence: 99%

Tractography dissection variability: what happens when 42 groups dissect 14 white matter bundles on the same dataset?

Schilling¹,

Rheault²,

Petit

et al. 2020

Preprint

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White matter bundle segmentation using diffusion MRI fiber tractography has become the method of choice to identify white matter fiber pathways in vivo in human brains. However, like other analyses of complex data, there is considerable variability in segmentation protocols and techniques. This can result in different reconstructions of the same intended white matter pathways, which directly affects tractography results, quantification, and interpretation. In this study, we aim to evaluate and quantify the variability that arises from different protocols for bundle segmentation. Through an open call to users of fiber tractography, including anatomists, clinicians, and algorithm developers, 42 independent teams were given processed sets of human wholebrain streamlines and asked to segment 14 white matter fascicles on six subjects. In total, we received 57 different bundle segmentation protocols, which enabled detailed volume-based and streamline-based analyses of agreement and disagreement among protocols for each fiber pathway. Results show that even when given the exact same sets of underlying streamlines, the variability across protocols for bundle segmentation is greater than all other sources of variability in the virtual dissection process, including variability within protocols and variability across subjects. In order to foster the use of tractography bundle dissection in routine clinical settings, and as a fundamental analytical tool, future endeavors must aim to resolve and reduce this heterogeneity. Although external validation is needed to verify the anatomical accuracy of bundle dissections, reducing heterogeneity is a step towards reproducible research and may be achieved through the use of standard nomenclature and definitions of white matter bundles and well-chosen constraints and decisions in the dissection process.

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Section: Inter-protocol Variabilitymentioning

confidence: 99%

Tractography dissection variability: what happens when 42 groups dissect 14 white matter bundles on the same dataset?

Schilling¹,

Rheault²,

Petit

et al. 2020

Preprint

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show abstract

“…We examined several white matter tracts originating in visual cortex and included the cerebellum and vermis, which are involved in the calibration of oculomotor tasks. The IFOF provides visual, oculomotor, and attentional connections between occipital cortex (fusiform, lingual, and lateral occipital areas) with areas in the temporal, frontal, and parietal lobes, [35][36][37] and the SLF, which links frontal eye fields with areas of the posterior parietal cortex within and in the vicinity of the IPS. 35,38 The OP, PP, and TP tracts are corticopontine fibers that connect the occipital, parietal, and temporal cortices to the pons, and likely play a role in eye movements.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Visual Impairment Characterized by Abnormal Visual Orienting Behavior With Preserved Visual Cortical Activation

Kelly

Phillips

Saneto

et al. 2021

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.Children with cerebral visual impairment (CVI) often have abnormal visual orienting behaviors due to impaired or damaged visual cortex. Alternatively, visualcortical function is intact but visual information is not transformed downstream into an appropriate oculomotor output (visuomotor dysfunction). We examined visual, anatomic, and oculomotor assessments to distinguish visuomotor dysfunction from CVI associated with severely reduced visual-cortical response. METHODS.We reviewed the medical records from children with CVI having abnormal visual orienting behaviors, normal ocular examinations, and born near term. Relevant data were visual evoked potentials (VEPs), Teller card acuity, eye movements recorded by video-oculography (VOG), and neuroimaging (magnetic resonance imaging [MRI]) including diffusion tensor imaging (DTI) tractography. RESULTS.Thirty subjects had visuomotor dysfunction based on a normal VEP; of these 33% had a normal MRI and 67% had white matter abnormalities associated with metabolic disease and/or decreased volume of brain parenchyma. VOG recordings showed smooth pursuit gains were uniformly reduced and saccades were dysmetric but followed the main sequence. Ten subjects had severe CVI based on VEPs at noise levels; visual acuities and MRI findings overlapped those of the visuomotor dysfunction group. Developmental delay, seizures, microcephaly, and hypotonia were common across all groups. All subjects with an abnormal conventional MRI had abnormal metrics on DTI tractography from the occipital lobe. CONCLUSIONS.A subset of patients with CVI have abnormal visual orienting behaviors despite a normal VEP (visuomotor dysfunction). A majority have abnormal white matter metrics on tractography suggesting a downstream defect in sensorimotor transformation. Clinically, visuomotor dysfunction is indistinguishable from severe CVI.

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“…By applying such strategy, GTR (>99%), NTR (>95%) and STR (80-95%) were reached in 30%, 42%, 28% of patients, respectively ( 25 ). Unfortunately, despite neuronavigated tractography and intraoperative neurophysiological monitoring, it is impossible to predict language and neuropsycological outcome with asleep craniotomy ( 47 – 49 ).…”

Section: Discussionmentioning

confidence: 99%

High Grade Glioma Treatment in Elderly People: Is It Different Than in Younger Patients? Analysis of Surgical Management Guided by an Intraoperative Multimodal Approach and Its Impact on Clinical Outcome

et al. 2021

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ObjectiveAge is considered a negative prognostic factor for High Grade Gliomas (HGGs) and many neurosurgeons remain skeptical about the benefits of aggressive treatment. New surgical and technological improvements may allow extended safe resection, with lower level of post-operative complications. This opportunity opens the unsolved question about the most appropriate HGG treatment in elderly patients. The aim of this study is to analyze if HGG maximal safe resection guided by an intraoperative multimodal imaging protocol coupled with neuromonitoring is associated with differences in outcome in elderly patients versus younger ones.MethodsWe reviewed 100 patients, 53 (53%) males and 47 (47%) females, with median (IQR) age of 64 (57; 72) years. Eight patients were diagnosed with Anaplastic Astrocytoma (AA), 92 with Glioblastoma (GBM). Surgery was aimed to achieve safe maximal resection. An intraoperative multimodal imaging protocol, including neuronavigation, neurophysiological monitoring, 5-ALA fluorescence, 11C MET-PET, navigated i-US system and i-CT, was used, and its impact on EOTR and clinical outcome in elderly patients was analyzed. We divided patients in two groups according to their age: <65 and >65 years, and surgical and clinical results (EOTR, post-operative KPS, OS and PFS) were compared. Yet, to better understand age-related differences, the same patient cohort was also divided into <70 and >70 years and all the above data reanalyzed.ResultsIn the first cohort division, we did not found KPS difference over time and survival analysis did not show significant difference between the two groups (p = 0.36 for OS and p = 0.49 for PFS). Same results were obtained increasing the age cut-off for age up to 70 years (p = 0.52 for OS and p = 0.92 for PFS).ConclusionsOur data demonstrate that there is not statistically significant difference in post-operative EOTR, KPS, OS, and PFS between younger and elderly patients treated with extensive tumor resection aided by a intraoperative multimodal protocol.

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Inferior Fronto-Occipital fascicle anatomy in brain tumor surgeries: From anatomy lab to surgical theater

Cited by 26 publications

References 18 publications

Tractography dissection variability: what happens when 42 groups dissect 14 white matter bundles on the same dataset?

Tractography dissection variability: what happens when 42 groups dissect 14 white matter bundles on the same dataset?

Cerebral Visual Impairment Characterized by Abnormal Visual Orienting Behavior With Preserved Visual Cortical Activation

High Grade Glioma Treatment in Elderly People: Is It Different Than in Younger Patients? Analysis of Surgical Management Guided by an Intraoperative Multimodal Approach and Its Impact on Clinical Outcome

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