Intraoperative three-dimensional visualization of the pyramidal tract in a neuronavigation system (PTV) reliably predicts true position of principal motor pathways

Coenen, Volker A.; Krings, Timo; Axer, Hubertus; Weidemann, Jürgen; Kränzlein, Heidi; Hans, Franz-Josef; Thron, A.; Gilsbach, Joachim M.; Rohde, Veit

doi:10.1016/s0090-3019(03)00392-6

Cited by 69 publications

(38 citation statements)

References 25 publications

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“…There are many ways to identify this important landmark 1,5,[7][8][9] . The use of the coronal suture as a point of reference, and especially, its relationship to the sulcus of the lateral surface of the frontal lobe, allows to estimate the assessment of the projection on the cranium of the superficial cerebral lesions, with the purpose of delimiting the surgical access and to guide the approach to the cerebral convexity.…”

Section: Discussionmentioning

confidence: 99%

Relationship between the coronal suture and the central lobe: how important is it and how can we use it in surgical planning?

Sarmento

Jácome

Andrade

et al. 2008

Arq. Neuro-Psiquiatr.

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-The surgical treatment of the lesions located in the central lobe is a very difficult task for the neurosurgeon. The overall aim of this study is to verify the correlation of the coronal suture and the structures of the central lobe in 32 cadaver hemisphere brains and the importance of this information in surgical planning. The measurement of the nasion to the coronal suture ranged from 11.5 to 13.5 cm. The distance between the coronal suture in the midline to the central, precentral and paracentral sulcus ranged from 5.0 to 6.6, 2.5 to 4.5 and 1.3 to 4.0 cm respectively. Particularly in the normal cortex these measurements can be used to guide the surgical access. However, the identification of the central sulcus is not easy when the anatomical pattern is distorted or displaced by a lesion or edema. In cases such as these the use of other tools becomes crucial for good surgical planning and cortical mapping or awake craniotomy for a safer resection of the lesion as well.Key words: coronal suture, central lobe, central sulcus, motor cortex, preoperative planning. Relação entre a sutura coronária e o lobo central: qual a sua importância e como podemos usá-la no planejamento cirurgico?Resumo -o tratamento cirúrgico de lesões localizadas no lobo central é difícil para o neurocirurgião. o objetivo deste estudo é verificar a relação da sutura coronária com as estruturas do lobo central utilizandose de dissecção realizada em 32 hemisférios cerebrais de 16 cadáveres, assim como, a importância desta informação no planejamento cirúrgico. A medida da distância entre o nasion e a sutura coronária variou entre 11,5 e 13,5 cm. A distância da sutura coronária na linha média para os sulcos central, pré-central e paracentral variou de 5,0 a 6,6 cm, 2,5 a 4,5 cm e 1,3 a 4,0 cm respectivamente. o conhecimento destas medidas pode ser usado no planejamento cirúrgico principalmente num córtex normal. Porém, a identificação do sulco central é difícil quando as estruturas anatômicas estão deslocadas pela lesão ou quando há edema. Nestes casos a utilização de outros meios diagnósticos para o planejamento cirúrgico torna-se necessária, como também a estimulação cortical ou a craniotomia com o paciente acordado pode proporcionar uma ressecção mais segura da lesão.PAlAvrAs-cHAve: sutura coronal, lobo central, sulco central, córtex motor, planejamento pré-operatório. The central lobe is a site of a wide variety of lesions and sometime surgeons need to approach it directly, for example in the resection of gliomas. However, manipulation in an eloquent area increases the risk of pos surgical complications and deficits. A knowledge of the morphological relationship of this lobe and its relationship to the craniometric points and sutures facilitates the approach to the lesion preserving neurovascular structures [1][2][3][4][5][6] . exact and correct localization of the central sulcus becomes crucial.

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Section: Discussionmentioning

confidence: 99%

Relationship between the coronal suture and the central lobe: how important is it and how can we use it in surgical planning?

Sarmento

Jácome

Andrade

et al. 2008

Arq. Neuro-Psiquiatr.

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“…Therefore, because fMRI of motor and language tasks is feasible in patients with cerebral tumors (Mueller et al 1996), several groups have proposed the integration of functional data into the neuronavigation system in recent years (Krishnan et al 2004, Gralla et al 2003, Jannin et al 2002, Roessler et al 2005, Reithmeier et al 2003, Talos et al 2003, O'Shea et al 2006. And strong evidence that a more radical tumor resection may be achieved by using fMRI information during neurosurgery has been demonstrated by Krishnan et al 2004, Haberg et al 2004 Diffusion tensor imaging (DTI) has recently emerged as a potentially valuable tool for preoperative planning (Tummala et al 2004, Field et al 2004, Clark et al 2003, Wieshmann et al 2000, Moller-Hartmann et al 2002, Coenen et al 2003 and postoperative follow-up (Alexander et al 2003) of surgically treated brain tumors and vascular malformations. DTI provides information about the normal course, displacement, or interruption of white matter tracts in and around a tumor, as well as detecting the widening of fiber bundles due to edema or tumor infiltration (Beppu et al, 2003;Clark et al, 2003;Hendler et al, 2003;Lu et al, 2003;Price et al, 2003;Tummala et al, 2003;Wieshmann et al, 1999;Yamada et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

“…DTI provides information about the normal course, displacement, or interruption of white matter tracts in and around a tumor, as well as detecting the widening of fiber bundles due to edema or tumor infiltration (Beppu et al, 2003;Clark et al, 2003;Hendler et al, 2003;Lu et al, 2003;Price et al, 2003;Tummala et al, 2003;Wieshmann et al, 1999;Yamada et al, 2003). Consequently, efforts have been made in recent years to integrate DTI data with neurosurgical navigation systems , Coenen et al 2003, Talos et al 2003, Berman et al 2004, Shinoura et al 2005, Nimsky et al 2006. Such a study on the role of diffusion tensor imaging of the corticospinal tract (CST) before and after mass resection, and the correlations with clinical motor findings, was recently published by Laundre et al 2005. Interventional MRI (iMRI) has proven to be an effective tool for improving the completeness of low grade glioma resection (Claus et al 2005, Bradley 2002, Schneider et al 2001, Schneider et al 2005, Knauth et al 1999, Wirtz et al 2000.…”

Section: Introductionmentioning

confidence: 99%

Non-rigid alignment of pre-operative MRI, fMRI, and DT-MRI with intra-operative MRI for enhanced visualization and navigation in image-guided neurosurgery

et al. 2007

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Objective-The usefulness of neurosurgical navigation with current visualizations is seriously compromised by brain shift, which inevitably occurs during the course of the operation, significantly degrading the precise alignment between the preoperative MR data and the intraoperative shape of the brain. Our objectives were (i) to evaluate the feasibility of non-rigid registration that compensates for the brain deformations within the time constraints imposed by neurosurgery, and (ii) create augmented reality visualizations of critical structural and functional brain regions during neurosurgery using pre-operatively acquired fMRI and DT-MRI.Materials and Methods-Eleven consecutive patients with supratentorial gliomas were included in our study. All underwent surgery at our intra-operative MR imaging-guided therapy facility and have tumors in eloquent brain areas (e.g. precentral gyrus and cortico-spinal tract). Functional MRI and DT-MRI, together with MPRAGE and T2w structural MRI were acquired at 3T prior to surgery. SPGR and T2w images were acquired with a 0.5T magnet during each procedure. Quantitative assessment of the alignment accuracy was carried out and compared with current state-of the-art systems based only on rigid-registration.Results-Alignment between preoperative and intra-operative datasets was successfully carried out during surgery for all patients. Overall, the mean residual displacement remaining after nonrigid registration was 1.82 mm. There is a statistically significant improvement in alignment accuracy utilizing our non-rigid registration in comparison to the currently used technology (p<0.001).Conclusions-We were able to achieve intra-operative rigid and non-rigid registration of (1) pre-operative structural MRI with intra-operative T1w MRI; (2) pre-operative FMRI with intraoperative T1w MRI, and (3) pre-operative DT-MRI with intra-operative T1w MRI. The registration algorithms as implemented were sufficiently robust and rapid to meet the hard realtime constraints of intra-operative surgical decision making. The validation experiments demonstrate that we can accurately compensate for the deformation of the brain and thus can construct an augmented reality visualization to aid the surgeon.

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“…Some of the neuronavigation companies even offer their own BOLD and DTI processing software, including software for basic tractography. Several recent studies have shown great promise for DTI incorporation into neuronavigation systems for surgical planning, [37][38][39][40] and similar studies have shown the added value of BOLD results when incorporated into neuronavigation systems. 41 Each of these studies will be described briefly.…”

Section: Emerging Role Of Bold and Dti In Neuronavigationmentioning

confidence: 99%

“…38 In 81 patients with high-grade gliomas, the median survival of patients undergoing preoperative DTI was 21.2 months compared with only 14.0 months for the control patients (P ϭ .048). 38 Coenen et al 39 compared the location of the preoperative DTI-based pyramidal tract outlined in neuronavigation with the tract outlined in surgery through subcortical intraoperative mapping in 13 patients with tumors adjacent to the pyramidal tracts or in perirolandic regions. They found that in 11 of the 13 patients (92%), the motor pathways were correctly predicted by preoperative DTT, by using subcortical intraoperative mapping as the criterion standard.…”

Section: Emerging Role Of Bold and Dti In Neuronavigationmentioning

confidence: 99%

The Evolution of Clinical Functional Imaging during the Past 2 Decades and Its Current Impact on Neurosurgical Planning

Pillai

2010

AJNR Am J Neuroradiol

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SUMMARY: BOLD fMRI has, during the past decade, made a major transition from a purely research imaging technique to a viable clinical technique used primarily for presurgical planning in patients with brain tumors and other resectable brain lesions. This review article briefly examines the history and evolution of clinical functional imaging, with particular emphasis on how the use of BOLD fMRI for neurosurgical planning has changed during the past 2 decades. Even more important, this article describes the many published studies during that same period that have examined the overall clinical impact that BOLD and DTI have made on surgical planning.ABBREVIATIONS: AF ϭ arcuate fasciculus; ASFNR ϭ American Society of Functional Neuroradiology; BOLD ϭ blood oxygen levelϪdependent; CPT ϭ current procedural terminology; CPU ϭ central processing unit; CSM ϭ intraoperative cortical stimulation mapping; DTI ϭ diffusion tensor imaging; DTT ϭ diffusion tensor tractography; EPI ϭ echo-planar imaging; FA ϭ fractional anisotropy; FDA ϭ US Food and Drug Administration; fMRI ϭ functional MR imaging; GLM ϭ general linear model; MEG ϭ magnetoencephalography; PACS ϭ picture archiving and communication system; QC ϭ quality control; RAM ϭ random access memory; SPM ϭ Statistical Parametric Mapping; TL ϭ temporal lobe; TLE ϭ temporal lobe epilepsy; Wada ϭ intracarotid sodium amobarbital test f MRI is a physiologic imaging technique that has rapidly evolved since the early 1990s when Ogawa et al 1-3 first described the BOLD principle, which was based on animal imaging studies and was considered novel. Human imaging applications arose only in 1991, when Belliveau et al 4 described mapping of the human visual cortex by using fMRI. Since those early days, fMRI has burgeoned into one of the most useful research techniques in modern cognitive neuroscience, with use by a wide variety of researchers in fields as diverse as psychology, neurology, psychiatry, and linguistics. However, clinical use of fMRI is a relatively recent phenomenon, with only slightly more than a decade of collective experience. This review article examines the history and evolution of clinical functional imaging, with special emphasis on BOLD and, to a lesser extent, DTI applications in clinical brain tumor imaging, which have served as early models for the clinical translation and maturation of these imaging modalities. In addition, this article describes the clinical impact that BOLD and DTI have made on surgical planning.The ASFNR was established in 2004 to address the unique concerns relating to clinical use of functional imaging, comprising not only BOLD imaging but also DTI, perfusion imaging, MEG/magnetic source imaging, and molecular and metabolic imaging, including MR spectroscopy. As all of these physiologic imaging modalities enter mainstream clinical neuroradiology, a growing need to establish national standards for their clinical use and standardized quality control metrics has emerged. The ASFNR, by planned launch of a multicenter study that will assess the...

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Intraoperative three-dimensional visualization of the pyramidal tract in a neuronavigation system (PTV) reliably predicts true position of principal motor pathways

Cited by 69 publications

References 25 publications

Relationship between the coronal suture and the central lobe: how important is it and how can we use it in surgical planning?

Relationship between the coronal suture and the central lobe: how important is it and how can we use it in surgical planning?

Non-rigid alignment of pre-operative MRI, fMRI, and DT-MRI with intra-operative MRI for enhanced visualization and navigation in image-guided neurosurgery

The Evolution of Clinical Functional Imaging during the Past 2 Decades and Its Current Impact on Neurosurgical Planning

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