Maximizing Sacral Chordoma Resection by Precise 3-Dimensional Tumor Modeling in the Operating Room Using Intraoperative Computed Tomography Registration with Preoperative Magnetic Resonance Imaging Fusion and Intraoperative Neuronavigation: A Case Series

2019 ◽  
Vol 125 ◽  
pp. e1125-e1131 ◽  
Author(s):  
Sanjay Konakondla ◽  
J. Andrew Albers ◽  
Xun Li ◽  
Sean M. Barber ◽  
Jonathan Nakhla ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Case Series ◽  
Resonance Imaging ◽  
Intraoperative Computed Tomography ◽  
3 Dimensional ◽  
Sacral Chordoma ◽  
Preoperative Magnetic Resonance ◽  
Tumor Modeling

REMNANTS OF OCCIPITAL VERTEBRAE

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 945-954 ◽  
Author(s):  
Arnold H. Menezes ◽  
Kathleen A. Fenoy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Prospective Study ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Occipital Condyle ◽  
Resonance Imaging ◽  
Lower Cranial Nerve ◽  
3 Dimensional

Abstract OBJECTIVE Developmental remnants around the foramen magnum, or proatlas segmentation abnormalities, have been recorded in postmortem studies but very rarely in a clinical setting. Because of their rarity, the pathological anatomy has been misunderstood, and treatment has been fraught with failures. The objectives of this prospective study were to understand the correlative anatomy, pathology, and embryology and to recognize the clinical presentation and gain insights on the treatment and management. METHODS Our craniovertebral junction (CVJ) database started in 1977 and comprises 5200 cases. This prospective study has retrieval capabilities. Neurodiagnostic studies changed with the evolution of imaging. Seventy-two patients were recognized as having symptomatic proatlas segmentation abnormalities. RESULTS Ventral bony masses from the clivus or medial occipital condyle occurred in 66% (44/72), lateral or anterolateral compressive masses in 37% (27 of 72 patients), and dorsal bony compression in 17% (12 of 72 patients). Hindbrain herniation was associated in 33%. The age at presentation was 3 to 23 years. Motor symptoms occurred in 72% (52 of 72 patients); palsies in Cranial Nerves IX, X, and XII in 33% (24 of 72 patients); and vertebrobasilar symptoms in 25% (18 of 72 patients). Trauma precipitated symptoms in 55% (40 of 72 patients). The best definition of the abnormality was demonstrated by 3-dimensional computed tomography combined with magnetic resonance imaging. Treatment was aimed at decompression of the pathology and stabilization. CONCLUSION Remnants of the occipital vertebrae around the foramen magnum were recognized in 72 of 5200 CVJ cases (7.2%). Magnetic resonance imaging with 3-dimensional computed tomography of the CVJ provides the best definition and understanding of the lesions. Brainstem myelopathy and lower cranial nerve deficits are common clinical presentations in the first and second decades of life. Treatment is aimed at decompression of the pathology and CVJ stabilization.

Volumetric Analysis of Intracranial Arteriovenous Malformations Contoured for CyberKnife Radiosurgery With 3-Dimensional Rotational Angiography vs Computed Tomography/Magnetic Resonance Imaging

Neurosurgery ◽  
2013 ◽  
Vol 73 (2) ◽  
pp. 262-270 ◽  
Author(s):  
Anand Veeravagu ◽  
Ake Hansasuta ◽  
Bowen Jiang ◽  
Aftab S. Karim ◽  
Iris C. Gibbs ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Confidence Interval ◽  
Cerebral Angiography ◽  
Resonance Imaging ◽  
3 Dimensional ◽  
Cyberknife Radiosurgery ◽  
The Mean ◽  
Volume Difference

Abstract BACKGROUND: Accurate target delineation has significant impact on brain arteriovenous malformation (AVM) obliteration, treatment success, and potential complications of stereotactic radiosurgery. OBJECTIVE: We compare the nidal contouring of AVMs using fused images of contrasted computed tomography (CT) and magnetic resonance imaging (MRI) with matched images of 3-dimensional (3-D) cerebral angiography for CyberKnife radiosurgery (CKRS) treatment planning. METHODS: Between May 2009 and April 2012, 3-D cerebral angiography was integrated into CKRS target planning for 30 consecutive patients. The AVM nidal target volumes were delineated using fused CT and MRI scans vs fused CT, MRI, and 3-D cerebral angiography for each patient. RESULTS: The mean volume of the AVM nidus contoured with the addition of 3-D cerebral angiography to the CT/MRI fusion (9.09 cm3, 95% confidence interval: 5.39 cm3-12.8 cm3) was statistically smaller than the mean volume contoured with CT/MRI fused scans alone (14.1 cm3, 95% confidence interval: 9.16 cm3-19.1 cm3), with a mean volume difference of δ = 5.01 cm3 (P = .001). Diffuse AVM nidus was associated with larger mean volume differences compared with a compact nidus (δ = 6.51 vs 2.11 cm3, P = .02). The mean volume difference was not statistically associated with the patient's sex (male δ = 5.61, female δ = 5.06, P = .84), previous hemorrhage status (yes δ = 5.69, no δ = 5.23, P = .86), or previous embolization status (yes δ = 6.80, no δ = 5.95, P = .11). CONCLUSION: For brain AVMs treated with CKRS, the addition of 3-D cerebral angiography to CT/MRI fusions for diagnostic accuracy results in a statistically significant reduction in contoured nidal volume compared with standard CT/MRI fusion-based contouring.

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