High-resolution ultrasonography and diffusion tensor tractography map normal nerve fascicles in relation to schwannoma tissue prior to resection

Report of 2 cases

Neil G. Simon M.B.B.S., F.R.A.C.P.1, Tene Cage M.D., Ph.D.2, Jared Narvid M.D.3, Roger Noss Ph.D.4, Cynthia Chin M.D.3, and Michel Kliot M.D.2
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  • 1 Departments of Neurology,
  • | 2 Neurological Surgery,
  • | 3 Radiology, and
  • | 4 Perioperative Services, University of California, San Francisco, California
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The goals of the present study were to demonstrate the ability of high-resolution ultrasonography to delineate normal nerve fascicles within or around peripheral nerve sheath tumors (NSTs). A blinded examiner evaluated 2 patients with symptomatic upper limb NSTs with high-resolution ultrasonography performed in the perioperative suite using a portable ultrasonography system. Ultrasonographic examinations located the tumor mass and identified the normal nerve fascicles associated with the mass. The locations of normal nerve tissue were mapped and correlated with results of MR tractography, operative inspection, and intraoperative electrophysiological monitoring. The study demonstrated a close correlation between normal nerve fascicles identified by ultrasonography, MR tractography, and intraoperative electrophysiological mapping. In particular, ultrasonographic examinations accurately identified the surface regions of the tumor without overlying normal nerve tissue. These preliminary data suggest that preoperative ultrasonographic examinations may provide valuable information, supplementary to the information obtained from intraoperative electrophysiological monitoring. Identification of normal nerve tissue prior to surgery may provide additional information regarding the risk of iatrogenic nerve injury during percutaneous tumor biopsy or open resection of the tumor and may also aid in selecting the optimum surgical approach.

Abbreviations used in this paper:

DTI = diffusion tensor imaging; FA = fractional anisotropy; HRUS = high-resolution ultrasonography; NST = nerve sheath tumor.

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Contributor Notes

Address correspondence to: Michel Kliot, M.D., Department of Neurological Surgery, University of California, San Francisco, 400 Parnassus Ave., Room A850D, Box 0112, San Francisco, CA 94143-0112. email: KliotM@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online March 14, 2014; DOI: 10.3171/2014.2.JNS131975.

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