Diffusion tensor imaging–based fiber tracking for prediction of the position of the facial nerve in relation to large vestibular schwannomas

Clinical article

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The reliable preoperative visualization of facial nerve location in relation to vestibular schwannoma (VS) would allow surgeons to plan tumor removal accordingly and may increase the safety of surgery. In this prospective study, the authors attempted to validate the reliability of facial nerve diffusion tensor (DT) imaging–based fiber tracking in a series of patients with large VSs. Furthermore, the authors evaluated the potential of this visualization technique to predict the morphological shape of the facial nerve (tumor compression–related flattening of the nerve).


Diffusion tensor imaging and anatomical images (constructive interference in steady state) were acquired in a series of 22 consecutive patients with large VSs and postprocessed with navigational software to obtain facial nerve fiber tracking. The location of the cerebellopontine angle (CPA) part of the nerve in relation to the tumor was recorded during surgery by the surgeon, who was blinded to the results of the fiber tracking. A correlative analysis was performed of the imaging-based location of the nerve compared with its in situ position in relation to the VS.


Fibers corresponding to the anatomical location and course of the facial nerve from the brainstem to the internal auditory meatus were identified with the DT imaging–based fiber tracking technique in all 22 cases. The location of the CPA segment of the facial nerve in relation to the VS determined during surgery corresponded to the location of the fibers, predicted by the DT imaging–based fiber tracking, in 20 (90.9%) of the 22 patients. No DT imaging–based fiber tracking correlates were found with the 2 morphological types of the nerve (compact or flat).


The current study of patients with large VSs has shown that the position of the facial nerve in relation to the tumor can be predicted reliably (in 91%) using DT imaging–based fiber tracking. These are preliminary results that need further verification in a larger series.

Abbreviations used in this paper: CISS = constructive interference in steady state; CPA = cerebellopontine angle; DT = diffusion tensor; VS = vestibular schwannoma.

Article Information

Address correspondence to: Mario Giordano, M.D., International Neuroscience Institute, Rudolf Pichlmayr Strasse 4, Hannover 30625, Germany. email: mario.giordano@alice.it.

Please include this information when citing this paper: published online August 26, 2011; DOI: 10.3171/2011.7.JNS11495.

© AANS, except where prohibited by US copyright law.



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    Case 17. Diffusion tensor imaging–based fiber tracking of the facial nerve using commercially available software for navigational surgical planning. Fiber tracking findings are fused with anatomical images, acquired using MR imaging CISS sequences. The facial nerve fibers are reconstructed and the lesion is segmented to obtain 3D images. In this case, the facial nerve courses along the anterior middle third of the tumor. A: Axial view showing the left facial nerve fibers (red) on the anterior surface of the VS (outlined in yellow). B: Coronal view showing the facial nerve fibers running on the anterior middle third of the tumor into the left internal auditory meatus. C: Three-dimensional reconstruction (anterior view) showing the spatial relationship between the facial nerve (red) and tumor (yellow).

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    Sagittal MR CISS sequences showing the 5 typical locations of the CPA segment of the facial nerve (red) depicted with DT imaging–based fiber tracking in relation to the tumor (T). Sagittal images show the facial nerve running along the anterior middle third (A), anterior inferior third (B), anterior superior third (C), inferior surface (D), and superior surface (E) of the lesion. CE = cerebellum.

  • View in gallery

    Case 5. Course of the facial nerve (Class T4a) along the anterior middle third of the tumor surface, as shown by the fiber tracking study (A) and determined during surgery (B). A: Preoperative 3D reconstruction of the facial nerve fibers (green) using neuronavigation software (anterior view). B: Intraoperative image confirming the accuracy of the fiber tracking data. FN = facial nerve; T = tumor.


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