Preoperative DTI Fiber Tracking (DTI-FT) reconstruction of functional tracts combined with intraoperative subcortical mapping (ISM) is potentially useful to improve surgical procedures in gliomas located in eloquent areas. Aims of the study are: (1) to evaluate the modifications of fiber trajectory induced by the tumor; (2) to validate preoperative DTI-FT results with intraoperative identification of functional subcortical sites through direct subcortical stimulation; (3) to evaluate the impact of preoperative DTI-FT reconstructions in a neuronavigational setup combined with ISM technique on duration and modalities of surgical procedures, and on functional outcome of the patients. Data are available on 64 patients (52 low-grade and 12 high-grade gliomas). DTI-FT was acquired by a 3-T MR scanner with a single-shot EPI sequence (TR/TE 8986/80 ms, b = 1000 s/mm) with gradients applied along 32 non-collinear directions. 3D Fast Field Echo (FFE) T1-weighted imaging (TR/TE 8/4 ms) was performed for anatomic guidance. The corticospinal tract (CST), superior longitudinal, inferior fronto-occipital and uncinatus fasciculi were reconstructed. Data were transferred to the neuronavigational system. Functional subcortical sites identified during ISM were correlated with fiber tracts depicted by DTI-FT. In high-grade gliomas, DTI-FT depicted tracts mostly at the tumor periphery; in low-grade gliomas, fibers were frequently located inside the tumor mass. There was a high correlation between DTI-FT and ISM (sensitivity for CST = 95%, language tracts = 97%). For a proper reconstruction of the tracts, it was necessary to use a low FA threshold of fiber tracking algorithm and to position additional regions of interest (ROIs). The combination of DTI-FT and ISM decreased the duration of surgery, patient fatigue, and intraoperative seizures. Combination of DTI-FT and ISM allows accurate identification of eloquent fiber tracts and enhances surgical performance and safety maintaining a high rate of functional preservation. © 2007 Elsevier Inc. All rights reserved.

Bello, L., Gambini, A., Castellano, A., Carrabba, G., Acerbi, F., Fava, M., et al. (2008). Motor and Language DTI Fiber Tracking Combined with Intraoperative Subcortical Mapping for Surgical Removal of Gliomas. NEUROIMAGE, 39, 369-382 [10.1016/j.neuroimage.2007.08.031].

Motor and Language DTI Fiber Tracking Combined with Intraoperative Subcortical Mapping for Surgical Removal of Gliomas

Carrabba, G;GIUSSANI, CARLO GIORGIO;CASAROTTI, ALESSANDRA;PAPAGNO, COSTANZA;
2008

Abstract

Preoperative DTI Fiber Tracking (DTI-FT) reconstruction of functional tracts combined with intraoperative subcortical mapping (ISM) is potentially useful to improve surgical procedures in gliomas located in eloquent areas. Aims of the study are: (1) to evaluate the modifications of fiber trajectory induced by the tumor; (2) to validate preoperative DTI-FT results with intraoperative identification of functional subcortical sites through direct subcortical stimulation; (3) to evaluate the impact of preoperative DTI-FT reconstructions in a neuronavigational setup combined with ISM technique on duration and modalities of surgical procedures, and on functional outcome of the patients. Data are available on 64 patients (52 low-grade and 12 high-grade gliomas). DTI-FT was acquired by a 3-T MR scanner with a single-shot EPI sequence (TR/TE 8986/80 ms, b = 1000 s/mm) with gradients applied along 32 non-collinear directions. 3D Fast Field Echo (FFE) T1-weighted imaging (TR/TE 8/4 ms) was performed for anatomic guidance. The corticospinal tract (CST), superior longitudinal, inferior fronto-occipital and uncinatus fasciculi were reconstructed. Data were transferred to the neuronavigational system. Functional subcortical sites identified during ISM were correlated with fiber tracts depicted by DTI-FT. In high-grade gliomas, DTI-FT depicted tracts mostly at the tumor periphery; in low-grade gliomas, fibers were frequently located inside the tumor mass. There was a high correlation between DTI-FT and ISM (sensitivity for CST = 95%, language tracts = 97%). For a proper reconstruction of the tracts, it was necessary to use a low FA threshold of fiber tracking algorithm and to position additional regions of interest (ROIs). The combination of DTI-FT and ISM decreased the duration of surgery, patient fatigue, and intraoperative seizures. Combination of DTI-FT and ISM allows accurate identification of eloquent fiber tracts and enhances surgical performance and safety maintaining a high rate of functional preservation. © 2007 Elsevier Inc. All rights reserved.
No
Articolo in rivista - Articolo scientifico
Scientifica
DTI, awake surgery
English
Bello, L., Gambini, A., Castellano, A., Carrabba, G., Acerbi, F., Fava, M., et al. (2008). Motor and Language DTI Fiber Tracking Combined with Intraoperative Subcortical Mapping for Surgical Removal of Gliomas. NEUROIMAGE, 39, 369-382 [10.1016/j.neuroimage.2007.08.031].
Bello, L; Gambini, A; Castellano, A; Carrabba, G; Acerbi, F; Fava, M; Giussani, C; Cadioli, M; Blasi, V; Casarotti, A; Papagno, C; Gupta, A; Scotti, G; Falini, A; Gaini, S
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/5200
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