High-definition fiber tracking guidance for intraparenchymal endoscopic port surgery

Technical note

View More View Less
  • 1 Department of Neurological Surgery, University of Pittsburgh Medical Center; and
  • 2 Departments of Psychology and
  • 3 Radiology, University of Pittsburgh, Pennsylvania
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

The authors have applied high-definition fiber tracking (HDFT) to the resection of an intraparenchymal dermoid cyst by using a minimally invasive endoscopic port. The lesion was located within the mesial frontal lobe, septal area, hypothalamus, and suprasellar recess. Using high-dimensional (256 directions) diffusion imaging, more than 250,000 fiber tracts were imaged before and after surgery. Trajectory planning using HDFT in a computer model was used to facilitate cannulation of the cyst with the endoscopic port. Analysis of the proposed initial surgical route was overlaid onto the fiber tracts and was predicted to produce substantial disruption to prefrontal projection fibers (anterior limb of the internal capsule) and the cingulum. Adjustment of the cannulation entry point 1 cm medially was predicted to cross the corpus callosum instead of the anterior limb of the internal capsule or the cingulum. Following cyst resection performed using endoscopic port surgery, postoperative imaging demonstrated accurate cannulation of the lesion, with improved quantitative signal from both the anterior limb of the internal capsule and the cingulum. The observed fiber preservation from the cingulum and the anterior limb of the internal capsule, with minor injury to the corpus callosum, was in close agreement with preoperative trajectory modeling. Comparison of pre- and postoperative HDFT data facilitated quantification of the benefits and costs of the surgical trajectory. Future studies will help to determine whether HDFT combined with endoscopic port surgery facilitates anatomical and functional preservation in such challenging cases.

Abbreviations used in this paper: DT = diffusion tensor; EPS = endoscopic port surgery; HDFT = high-definition fiber tracking.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Johnathan A. Engh, M.D., Department of Neurological Surgery, UPMC Presbyterian, 200 Lothrop Street, Suite B-400, Pittsburgh, Pennsylvania 15213. email: enghja@upmc.edu.

Current address for Dr. Kassam: Brain Tumor Center, Saint John's Health Center, Santa Monica, California 90404.

Please include this information when citing this paper: published online November 27, 2009; DOI: 10.3171/2009.10.JNS09933.

  • 1

    Alexander DC, & Barker GJ: Optimal imaging parameters for fiber-orientation estimation in diffusion MRI. Neuroimage 27:357367, 2005

  • 2

    Berman JI, , Berger MS, , Mukherjee P, & Henry RG: Diffusion-tensor imaging-guided tracking of fibers of the pyramidal tract combined with intraoperative cortical stimulation mapping in patients with gliomas. J Neurosurg 101:6672, 2004

    • Search Google Scholar
    • Export Citation
  • 3

    Buchsbaum MS, , Schoenknecht P, , Torosjan Y, , Newmark R, , Chu KW, & Mitelman S, : Diffusion tensor imaging of frontal lobe white matter tracts in schizophrenia. Ann Gen Psychiatry 5:19, 2006

    • Search Google Scholar
    • Export Citation
  • 4

    Duffau H: New concepts in surgery of WHO grade II gliomas: functional brain mapping, connectionism and plasticity—a review. J Neurooncol 79:77115, 2006

    • Search Google Scholar
    • Export Citation
  • 5

    Duran FL, , Hoexter MQ, , Valente AA Jr, , Miguel EC, & Busatto GF: Association between symptom severity and internal capsule volume in obsessive-compulsive disorder. Neurosci Lett 452:6871, 2009

    • Search Google Scholar
    • Export Citation
  • 6

    Fernández-Miranda JC, , Rhoton AL, , Alvarez-Linera J, , Kakizawa Y, , Choi C, & de Oliveira E: Three-dimensional microsurgical and tractographic anatomy of the white matter of the human brain. Neurosurgery 62:6 Suppl 3 SHC989SHC1028, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Fernández-Miranda JC, , Rhoton AL Jr, , Kakizawa Y, , Choi C, & Alvarez-Linera J: The claustrum and its projection system in the human brain: a microsurgical and tractographic anatomical study. J Neurosurg 108:764774, 2008

    • Search Google Scholar
    • Export Citation
  • 8

    Harris AE, , Hadjipanayis CG, , Lunsford LD, , Lunsford AK, & Kassam AB: Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance. Neurosurgery 56:2 Suppl ONS125ONS132, 2005

    • Search Google Scholar
    • Export Citation
  • 9

    Henry RG, , Berman JI, , Nagarajan SS, , Mukherjee P, & Berger MS: Subcortical pathways serving cortical language sites: initial experience with diffusion tensor imaging fiber tracking combined with intraoperative language mapping. Neuroimage 21:616622, 2004

    • Search Google Scholar
    • Export Citation
  • 10

    Jung JH, , Kam SC, , Choi SM, , Jae SU, , Lee SH, & Hyun JS: Sexual dysfunction in male stroke patients: correlation between brain lesions and sexual function. Urology 71:99103, 2008

    • Search Google Scholar
    • Export Citation
  • 11

    Kamada K, , Sawamura Y, , Takeuchi F, , Kawaguchi H, , Kuriki S, & Todo T, : Functional identification of the primary motor area by corticospinal tractography. Neurosurgery 56:1 Suppl 98109, 2005

    • Search Google Scholar
    • Export Citation
  • 12

    Kamada K, , Todo T, , Masutani Y, , Aoki S, , Ino K, & Morita A, : Visualization of the frontotemporal language fibers by tractography combined with functional magnetic resonance imaging and magnetoencephalography. J Neurosurg 106:9098, 2007

    • Search Google Scholar
    • Export Citation
  • 13

    Kamada K, , Todo T, , Masutani Y, , Aoki S, , Ino K, & Takano T, : Combined use of tractography-integrated functional neuronavigation and direct fiber stimulation. J Neurosurg 102:664672, 2005

    • Search Google Scholar
    • Export Citation
  • 14

    Kamada K, , Todo T, , Morita A, , Masutani Y, , Aoki S, & Ino K, : Functional monitoring for visual pathway using real-time visual evoked potentials and optic-radiation tractography. Neurosurgery 57:1 Suppl 121127, 2005

    • Search Google Scholar
    • Export Citation
  • 15

    Kassam AB, , Engh JA, , Mintz AH, & Prevedello DM: Completely endoscopic resection of intraparenchymal brain tumors. J Neurosurg 110:116123, 2009

    • Search Google Scholar
    • Export Citation
  • 16

    Nimsky C, , Ganslandt O, & Fahlbusch R: Implementation of fiber tract navigation. Neurosurgery 58:4 Suppl 2 292303, 2006

  • 17

    Nimsky C, , Ganslandt O, , Hastreiter P, , Wang R, , Benner T, & Sorensen AG, : Intraoperative diffusion-tensor MR imaging: shifting of white matter tracts during neurosurgical procedures—initial experience. Radiology 234:218225, 2005

    • Search Google Scholar
    • Export Citation
  • 18

    Nimsky C, , Ganslandt O, , Hastreiter P, , Wang R, , Benner T, & Sorensen AG, : Preoperative and intraoperative diffusion tensor imaging-based fiber tracking in glioma surgery. Neurosurgery 56:130138, 2005

    • Search Google Scholar
    • Export Citation
  • 19

    Nimsky C, , Ganslandt O, , Merhof D, , Sorensen AG, & Fahlbusch R: Intraoperative visualization of the pyramidal tract by diffusion-tensor-imaging-based fiber tracking. Neuroimage 30:12191229, 2006

    • Search Google Scholar
    • Export Citation
  • 20

    Rhoton AL Jr: The cerebrum. Neurosurgery 51:4 Suppl S1S51, 2002

  • 21

    Schmahmann JD, & Pandya DN: Fiber Pathways of the Brain New York, Oxford University Press, 2006

  • 22

    Schmahmann JD, & Pandya DN: Prefrontal cortex projections to the basilar pons in rhesus monkey: implications for the cerebellar contribution to higher function. Neurosci Lett 199:175178, 1995

    • Search Google Scholar
    • Export Citation
  • 23

    Schmahmann JD, , Pandya DN, , Wang R, , Dai G, , D'Arceuil HE, & de Crespigny AJ, : Association fibre pathways of the brain: parallel observations from diffusion spectrum imaging and autoradiography. Brain 130:630653, 2007

    • Search Google Scholar
    • Export Citation
  • 24

    Türe U, , Yaşargil MG, , Friedman AH, & Al-Mefty O: Fiber dissection technique: lateral aspect of the brain. Neurosurgery 47:417427, 2000

    • Search Google Scholar
    • Export Citation
  • 25

    Wang R, & Wedeen VJ: ISMRM abstract proceedings. Intl Soc Mag Reson Med 15:3720, 2007

Metrics

All Time Past Year Past 30 Days
Abstract Views 418 233 9
Full Text Views 222 22 0
PDF Downloads 60 9 0
EPUB Downloads 0 0 0