Intraoperative Use and Benefits of Tractography in Awake Surgery Patients

Aibar-Durán, Juan Ángel; Quintana-Schmidt, Cristian de; Holzpafel, María Jesús Álvarez; Hernández, Fernando Muñoz; Cortés, Carlos Asencio; Martínez, Gloria Villalba; Bertrán, Gerardo Conesa

doi:10.1016/j.wneu.2020.01.210

Cited by 9 publications

(23 citation statements)

References 17 publications

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“…A randomized controlled trial reported fewer performance deteriorations after surgeries informed by DT than performed without DT [ 26 ]. Concordantly, a recent prospective study reported positive predictive value of DT for resection extent [ 43 ], confirming previous findings [ 17 ].…”

Section: Discussionsupporting

confidence: 89%

Diffusion tractography for awake craniotomy: accuracy and factors affecting specificity

et al. 2021

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Introduction Despite evidence of correspondence with intraoperative stimulation, there remains limited data on MRI diffusion tractography (DT)’s sensitivity to predict morbidity after neurosurgical oncology treatment. Our aims were: (1) evaluate DT against subcortical stimulation mapping and performance changes during and after awake neurosurgery; (2) evaluate utility of early post-operative DT to predict recovery from post-surgical deficits. Methods We retrospectively reviewed our first 100 awake neurosurgery procedures using DT- neuronavigation. Intra-operative stimulation and performance outcomes were assessed to classify DT predictions for sensitivity and specificity calculations. Post-operative DT data, available in 51 patients, were inspected for tract damage. Results 91 adult brain tumor patients (mean 49.2 years, 43 women) underwent 100 awake surgeries with subcortical stimulation between 2014 and 2019. Sensitivity and specificity of pre-operative DT predictions were 92.2% and 69.2%, varying among tracts. Post-operative deficits occurred after 41 procedures (39%), but were prolonged (> 3 months) in only 4 patients (4%). Post-operative DT in general confirmed surgical preservation of tracts. Post-operative DT anticipated complete recovery in a patient with supplementary motor area syndrome, and indicated infarct-related damage to corticospinal fibers associated with delayed, partial recovery in a second patient. Conclusions Pre-operative DT provided very accurate predictions of the spatial location of tracts in relation to a tumor. As expected, however, the presence of a tract did not inform its functional status, resulting in variable DT specificity among individual tracts. While prolonged deficits were rare, DT in the immediate post-operative period offered additional potential to monitor neurological deficits and anticipate recovery potential.

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Section: Discussionsupporting

confidence: 89%

Diffusion tractography for awake craniotomy: accuracy and factors affecting specificity

et al. 2021

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“…The articles were published from the year 2005 to 2021. The studies included both prospective studies (n = 9) [7,8,[19][20][21][22][23][24][25] and retrospective (n = 8) [1,[26][27][28][29][30][31][32]. Data collection was performed by extracting information on demographic data, composed of the author, year of publication, type of study, origin country, number of patients and participants, patients' mean age, tumor type and its histology, tumor location, and the details of the control group, as shown in Table 2.…”

Section: Data Extraction and Study Designmentioning

confidence: 99%

“…This information is summarized in Table 2. The white matter tracts of interest in the studies were primarily those in close proximity to the tumor and those associated with brain function, such as the corticospinal tract related to motor function [19,20,27,[30][31][32], optic radiation responsible for eyesight [1,7,8,21,23,29,31], and inferior longitudinal fasciculus and arcuate fascicles that link to language [7,8,20,22,23,28,29,31]. These tracts were relevant for postoperative deficit assessment.…”

Section: Participantsmentioning

confidence: 99%

“…All of the studies discussed the utilization of the DTI in brain tumor resection. One of them was primarily concerned with the ability to reconstruct the fiber tract in the presence of a brain tumor [1,7,8,[19][20][21][22][23][24][25][26][27][28][29][30][31][32]. In addition, the use of DTI could predetermine the preplanning surgical approach [8].…”

Section: Utilization Of Dti In Brain Resection Surgerymentioning

confidence: 99%

“…In addition, the use of DTI could predetermine the preplanning surgical approach [8]. Evaluation of DTI was performed in comparison with control patients, non-DTI, and DTI patients' groups [1,[21][22][23]25,28]; intraoperatively evaluation [1,7,8,[19][20][21][22][23][24][25][26][27][28][29][30][31]; and quantified the sensitivity and specificity of the DTI technique in its tract identification, tumor resection rate, and mobility prediction [20,21,23,24,27,31]. We emphasized all these benefits of DTI for our primary investigation on whether re-evaluation and modifications of the preplanning surgery were made [7,8,26,27,29,30,32].…”

Section: Utilization Of Dti In Brain Resection Surgerymentioning

confidence: 99%

See 2 more Smart Citations

The Utilization of Diffusion Tensor Imaging as an Image-Guided Tool in Brain Tumor Resection Surgery: A Systematic Review

Manan

Yahya

Idris

et al. 2022

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The diffusion tensor imaging technique has been recognized as a neuroimaging tool for in vivo visualization of white matter tracts. However, DTI is not a routine procedure for preoperative planning for brain tumor resection. Our study aimed to systematically evaluate the effectiveness of DTI and the outcomes of surgery. The electronic databases, PubMed/MEDLINE and Scopus, were searched for relevant studies. Studies were systematically reviewed based on the application of DTI in pre-surgical planning, modification of operative planning, re-evaluation of preoperative DTI data intraoperatively, and the outcome of surgery decisions. Seventeen studies were selected based on the inclusion and exclusion criteria. Most studies agreed that preoperative planning using DTI improves postoperative neuro-deficits, giving a greater resection yield and shortening the surgery time. The results also indicate that the re-evaluation of preoperative DTI intraoperatively assists in a better visualization of white matter tract shifts. Seven studies also suggested that DTI modified the surgical decision of the initial surgical approach and the rate of the GTR in tumor resection surgery. The utilization of DTI may give essential information on white matter tract pathways, for a better surgical approach, and eventually reduce the risk of neurologic deficits after surgery.

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Mapping the Brain During Awake Surgery for Patients with Neurological Disorders Including Brain Tumors

Ruiz‐Garcia

Middlebrooks

Sabsevitz

et al. 2020

Principles of Neuro-Oncology

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Intraoperative Use and Benefits of Tractography in Awake Surgery Patients

Cited by 9 publications

References 17 publications

Diffusion tractography for awake craniotomy: accuracy and factors affecting specificity

Diffusion tractography for awake craniotomy: accuracy and factors affecting specificity

The Utilization of Diffusion Tensor Imaging as an Image-Guided Tool in Brain Tumor Resection Surgery: A Systematic Review

Mapping the Brain During Awake Surgery for Patients with Neurological Disorders Including Brain Tumors

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