Preoperative Identification of Facial Nerve in Vestibular Schwannomas Surgery Using Diffusion Tensor Tractography

Choi, Kyung‐Sik; Kim, Minsu; Kwon, Hyeok Gyu; Kim, Oh-Lyong

doi:10.3340/jkns.2014.56.1.11

Cited by 20 publications

(9 citation statements)

References 25 publications

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“…11 Hodaie et al introduced DTT to cranial nerve tracking. 9 Taoka et al first reported the use of tracking the FN with DTT in patients with VS. 20 Since then, several investigators have described their experience in applying this technique to reconstruct the FN tract in patients with VS. 2,4,6,8,11,13,15,19,20,22,24,[27][28][29] Diffusion tensor tractography reconstruction of FN fibers is considered successful if a continuous tract of fibers is seen to extend from the internal auditory meatus to the brainstem along the tumor capsule. 4…”

Section: Diffusion Tensor Imaging-fiber Tracking For Fn Localizationmentioning

confidence: 99%

Preoperative diffusion tensor imaging–fiber tracking for facial nerve identification in vestibular schwannoma: a systematic review on its evolution and current status with a pooled data analysis of surgical concordance rates

Savardekar¹,

Patra²,

Thakur³

et al. 2018

Neurosurgical Focus

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OBJECTIVETotal tumor excision with the preservation of neurological function and quality of life is the goal of modern-day vestibular schwannoma (VS) surgery. Postoperative facial nerve (FN) paralysis is a devastating complication of VS surgery. Determining the course of the FN in relation to a VS preoperatively is invaluable to the neurosurgeon and is likely to enhance surgical safety with respect to FN function. Diffusion tensor imaging–fiber tracking (DTI-FT) technology is slowly gaining traction as a viable tool for preoperative FN visualization in patients with VS.METHODSA systematic review of the literature in the PubMed, Cochrane Library, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and those studies that preoperatively localized the FN in relation to a VS using the DTI-FT technique and verified those preoperative FN tracking results by using microscopic observation and electrophysiological monitoring during microsurgery were included. A pooled analysis of studies was performed to calculate the surgical concordance rate (accuracy) of DTI-FT technology for FN localization.RESULTSFourteen studies included 234 VS patients (male/female ratio 1:1.4, age range 17–75 years) who had undergone preoperative DTI-FT for FN identification. The mean tumor size among the studies ranged from 29 to 41.3 mm. Preoperative DTI-FT could not visualize the FN tract in 8 patients (3.4%) and its findings could not be verified in 3 patients (1.2%), were verified but discordant in 18 patients (7.6%), and were verified and concordant in 205 patients (87.1%).CONCLUSIONSPreoperative DTI-FT for FN identification is a useful adjunct in the surgical planning for large VSs (> 2.5 cm). A pooled analysis showed that DTI-FT successfully identifies the complete FN course in 96.6% of VSs (226 of 234 cases) and that FN identification by DTI-FT is accurate in 90.6% of cases (205 of 226 cases). Larger studies with DTI-FT–integrated neuronavigation are required to look at the direct benefit offered by this specific technique in preserving postoperative FN function.

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Section: Diffusion Tensor Imaging-fiber Tracking For Fn Localizationmentioning

confidence: 99%

Preoperative diffusion tensor imaging–fiber tracking for facial nerve identification in vestibular schwannoma: a systematic review on its evolution and current status with a pooled data analysis of surgical concordance rates

Savardekar¹,

Patra²,

Thakur³

et al. 2018

Neurosurgical Focus

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“…A maximum of 959 participants were included across all studies (ranging from 1 to 150 subjects per study), if multiple studies form a single institution did not include overlapping patient groups. Twenty-two studies focused on imaging the cranial nerves in relation to a posterior fossa tumor (Taoka et al, 2006; Chen et al, 2011; Gerganov et al, 2011; Roundy et al, 2012; Zhang et al, 2013, 2017; Choi et al, 2014; Ulrich et al, 2014; Wei et al, 2015, 2016; Yoshino et al, 2015a,b, 2016; Borkar et al, 2016; Hilly et al, 2016; Ma et al, 2016; Song et al, 2016; Behan et al, 2017; d'Almeida et al, 2017; Li et al, 2017; Zolal et al, 2017a,b), 16 studies imaged the trigeminal nerve in patients with trigeminal neuralgia (Herweh et al, 2007; Fujiwara et al, 2011; Leal et al, 2011; Lutz et al, 2011, 2016; Hodaie et al, 2012; Liu et al, 2013; Wilcox et al, 2013; DeSouza et al, 2014, 2015; Lummel et al, 2015; Chen, D. Q. et al, 2016; Chen, S. T. et al, 2016; Lin et al, 2016; Neetu et al, 2016; Hung et al, 2017) and the remaining 3 studies evaluated DTI and tractography of the cranial nerves in various other pathologies including the cochlear nerve in cases of unilateral deafness (Vos et al, 2015), and the trigeminal nerve in patients with herpetic keratouveitis (Rousseau et al, 2015) and short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) (Coskun et al, 2017) (Tables 1–3).…”

Section: Resultsmentioning

confidence: 99%

Clinical Applications for Diffusion MRI and Tractography of Cranial Nerves Within the Posterior Fossa: A Systematic Review

et al. 2019

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Objective: This paper presents a systematic review of diffusion MRI (dMRI) and tractography of cranial nerves within the posterior fossa. We assess the effectiveness of the diffusion imaging methods used and examine their clinical applications. Methods: The Pubmed, Web of Science and EMBASE databases were searched from January 1st 1997 to December 11th 2017 to identify relevant publications. Any study reporting the use of diffusion imaging and/or tractography in patients with confirmed cranial nerve pathology was eligible for selection. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool. Results: We included 41 studies comprising 16 studies of patients with trigeminal neuralgia (TN), 22 studies of patients with a posterior fossa tumor and three studies of patients with other pathologies. Most acquisition protocols used single-shot echo planar imaging (88%) with a single b-value of 1,000 s/mm 2 (78%) but there was significant variation in the number of gradient directions, in-plane resolution, and slice thickness between studies. dMRI of the trigeminal nerve generated interpretable data in all cases. Analysis of diffusivity measurements found significantly lower fractional anisotropy (FA) values within the root entry zone of nerves affected by TN and FA values were significantly lower in patients with multiple sclerosis. Diffusivity values within the trigeminal nerve correlate with the effectiveness of surgical treatment and there is some evidence that pre-operative measurements may be predictive of treatment outcome. Fiber tractography was performed in 30 studies (73%). Most studies evaluating fiber tractography involved patients with a vestibular schwannoma (82%) and focused on generating tractography of the facial nerve to assist with surgical planning. Deterministic tractography using diffusion tensor imaging was performed in 93% of cases but the reported success rate and accuracy of generating fiber tracts from the acquired diffusion data varied considerably. Conclusions: dMRI has the potential to inform our understanding of the microstructural changes that occur within the cranial nerves in various pathologies. Cranial nerve tractography is a promising technique but new avenues of using dMRI should be explored to optimize and improve its reliability.

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“…Diffusion tensor tractography for the preoperative identifica-tion of the facial nerve in vestibular schwannoma surgery was performed in recent studies. 11 Also, meticulous intraoperative monitoring can significantly minimize the facial nerve morbidity in the surgery for contiguous tumors. 12…”

Section: Discussionmentioning

confidence: 99%

Cerebellopontine Angle Schwannoma and Meningioma in Contiguity: Surgical Implications in Neurofibromatosis

Nehete

Nandeesh

Bharath

et al. 2017

J Neurol Surg A Cent Eur Neurosurg

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Concurrent occurrence of brain tumors in the same location is very unusual and has been noted in patients with neurofibromatosis. Two lesions, occurring in close contact but of different histology, are called contiguous tumors. Schwannoma and meningioma are the two common histologies reported to present as contiguous tumor. We present two patients with contiguous tumors in the cerebellopontine angle. The magnetic resonance imaging characteristics in both cases demonstrate important findings that should be identified to raise the possibility of contiguous tumors. We discuss the surgical implications in identifying the facial nerve in this complex tumor morphology and steps we took to preserve function. Variable displacement of the facial nerve in the presence of multiple tumors needs to be kept in mind during surgical management and can be significantly aided by intraoperative monitoring.

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Preoperative Identification of Facial Nerve in Vestibular Schwannomas Surgery Using Diffusion Tensor Tractography

Cited by 20 publications

References 25 publications

Preoperative diffusion tensor imaging–fiber tracking for facial nerve identification in vestibular schwannoma: a systematic review on its evolution and current status with a pooled data analysis of surgical concordance rates

Preoperative diffusion tensor imaging–fiber tracking for facial nerve identification in vestibular schwannoma: a systematic review on its evolution and current status with a pooled data analysis of surgical concordance rates

Clinical Applications for Diffusion MRI and Tractography of Cranial Nerves Within the Posterior Fossa: A Systematic Review

Cerebellopontine Angle Schwannoma and Meningioma in Contiguity: Surgical Implications in Neurofibromatosis

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