Real-Time Atlas-Based Stereotactic Neuronavigation

Abstract BACKGROUND: Surgery for tumors in eloquent brain faces immense challenges when attempting to maximize resection and avoid neurological deficits. OBJECTIVE: In order to give the surgeon real-time atlas-based anatomic information linked to the patient's anatomy, we developed a software-based interface between deformable anatomic templates (DATs) and an intraoperative navigation system. METHODS: Magnetic resonance imaging (MRI), diffusion tensor imaging, and/or functional MRI were performed on 3 patients preoperatively for the purposes of tumor resection by the use of neuronavigation. The DAT was registered to the patients' navigation coordinate system and utilized coordinates from the navigation system during surgery. This provided the surgeon with a list of proximal anatomic and functional structures and a real-time image of the atlas at that location fused to the patient's MRI. The clinical feasibility of this approach was evaluated during the resection of 3 eloquent tumors (right postcentral gyrus, left inferior frontal gyrus, and left occipital cuneus gyrus). RESULTS: Tumor resection was performed successfully in all 3 patients. With the use of the coordinates from the navigation system, anatomic and functional structures and their distances were visualized interactively during tumor resection by using the DAT. CONCLUSION: This is a proof of concept that an interactive atlas-based navigation can provide detailed anatomic and functional information that supplements MRI, diffusion tensor imaging, and functional MRI. The atlas-based navigation generated distances to important anatomic structures from the navigation probe tip. It can be used to guide direct electrical stimulation and highlight areas to avoid during tumor resection.

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Intraoperative Real-Time Querying of White Matter Tracts During Frameless Stereotactic Neuronavigation

Neurosurgery ◽

10.1227/neu.0b013e3182036282 ◽

2011 ◽

Vol 68 (2) ◽

pp. 506-516 ◽

Cited By ~ 30

Author(s):

Haytham Elhawary ◽

Haiying Liu ◽

Pratik Patel ◽

Isaiah Norton ◽

Laura Rigolo ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

White Matter ◽

Magnetic Resonance ◽

Real Time ◽

Navigation System ◽

Diffusion Tensor ◽

Tumor Resection ◽

Resonance Imaging ◽

Surgical Tool ◽

Tractography Data

Abstract BACKGROUND: Brain surgery faces important challenges when trying to achieve maximum tumor resection while avoiding postoperative neurological deficits. OBJECTIVE: For surgeons to have optimal intraoperative information concerning white matter (WM) anatomy, we developed a platform that allows the intraoperative real-time querying of tractography data sets during frameless stereotactic neuronavigation. METHODS: Structural magnetic resonance imaging, functional magnetic resonance imaging, and diffusion tensor imaging were performed on 5 patients before they underwent lesion resection using neuronavigation. During the procedure, the tracked surgical tool tip position was transferred from the navigation system to the 3-dimensional Slicer software package, which used this position to seed the WM tracts around the tool tip location, rendering a geometric visualization of these tracts on the preoperative images previously loaded onto the navigation system. The clinical feasibility of this approach was evaluated in 5 cases of lesion resection. In addition, system performance was evaluated by measuring the latency between surgical tool tracking and visualization of the seeded WM tracts. RESULTS: Lesion resection was performed successfully in all 5 patients. The seeded WM tracts close to the lesion and other critical structures, as defined by the functional and structural images, were interactively visualized during the intervention to determine their spatial relationships relative to the lesion and critical cortical areas. Latency between tracking and visualization of tracts was less than a second for a fiducial radius size of 4 to 5 mm. CONCLUSION: Interactive tractography can provide an intuitive way to inspect critical WM tracts in the vicinity of the surgical region, allowing the surgeon to have increased intraoperative WM information to execute the planned surgical resection.

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Functional MRI, Diffusion Tensor Imaging, Magnetic Source Imaging and Intraoperative Neuromonitoring Guided Brain Tumor Resection in Awake and Under General Anaesthesia

Clinical Management and Evolving Novel Therapeutic Strategies for Patients with Brain Tumors ◽

10.5772/52032 ◽

2013 ◽

Cited By ~ 2

Author(s):

Zamzuri Idris ◽

W M Nazaruddin W Hassan ◽

Muzaimi Mustapha ◽

Badrisyah Idris ◽

Rahman Izaini ◽

...

Keyword(s):

Brain Tumor ◽

Diffusion Tensor Imaging ◽

General Anaesthesia ◽

Functional Mri ◽

Diffusion Tensor ◽

Tumor Resection ◽

Intraoperative Neuromonitoring ◽

Source Imaging ◽

Magnetic Source Imaging ◽

Brain Tumor Resection

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Intraoperative mapping and monitoring of the corticospinal tracts with neurophysiological assessment and 3-dimensional ultrasonography-based navigation

Journal of Neurosurgery ◽

10.3171/2010.8.jns10639 ◽

2011 ◽

Vol 114 (3) ◽

pp. 738-746 ◽

Cited By ~ 89

Author(s):

Erez Nossek ◽

Akiva Korn ◽

Tal Shahar ◽

Andrew A. Kanner ◽

Hillary Yaffe ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Real Time ◽

Motor Function ◽

Diffusion Tensor ◽

Tumor Resection ◽

Intraoperative Ultrasonography ◽

Brain Shift ◽

Corticospinal Tracts ◽

Subcortical Stimulation ◽

Neurophysiological Assessment

Object Preserving motor function is a major challenge in surgery for intraaxial brain tumors. Navigation systems are unreliable in predicting the location of the corticospinal tracts (CSTs) because of brain shift and the inability of current intraoperative systems to produce reliable diffusion tensor imaging data. The authors describe their experience with elaborate neurophysiological assessment and tractography-based navigation, corrected in real time by 3D intraoperative ultrasonography (IOUS) to identify motor pathways during subcortical tumor resection. Methods A retrospective analysis was conducted in 55 patients undergoing resection of tumors located within or in proximity to the CSTs at the authors' institution between November 2007 and June 2009. Corticospinal tract tractography was coregistered to surgical navigation-derived images in 42 patients. Direct cortical-stimulated motor evoked potentials (dcMEPs) and subcortical-stimulated MEPs (scrtMEPs) were recorded intraoperatively to assess function and estimate the distance from the CSTs. Intraoperative ultrasonography updated the navigation imaging and estimated resection proximity to the CSTs. Preoperative clinical motor function was compared with postoperative outcome at several time points and correlated with incidences of intraoperative dcMEP alarm and low scrtMEP values. Results The threshold level needed to elicit scrtMEPs was plotted against the distance to the CSTs based on diffusion tensor imaging tractography after brain shift compensation with 3D IOUS, generating a trend line that demonstrated a linear order between these variables, and a relationship of 0.97 mA for every 1 mm of brain tissue distance from the CSTs. Clinically, 39 (71%) of 55 patients had no postoperative deficits, and 9 of the remaining 16 improved to baseline function within 1 month. Seven patients had varying degrees of permanent motor deficits. Subcortical stimulation was applied in 45 of the procedures. The status of 32 patients did not deteriorate postoperatively (stable or improved motor status): 27 of them (84%) displayed minimum scrtMEP thresholds > 7 mA. Six patients who experienced postoperative deterioration quickly recovered (within 5 days) and displayed minimum scrtMEP thresholds > 6.8 mA. Five of the 7 patients who had late (> 5 days postoperatively) or no recovery had minimal scrtMEP thresholds < 3 mA. An scrtMEP threshold of 3 mA was found to be the cutoff point below which irreversible disruption of CST integrity may be anticipated (sensitivity 83%, specificity 95%). Conclusions Combining elaborate neurophysiological assessment, tractography-based neuronavigation, and updated IOUS images provided accurate localization of the CSTs and enabled the safe resection of tumors approximating these tracts. This is the first attempt to evaluate the distance from the CSTs using the threshold of subcortical monopolar stimulation with real-time IOUS for the correction of brain shift. The linear correlation between the distance to the CSTs and the threshold of subcortical stimulation producing a motor response provides an intraoperative technique to better preserve motor function.

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Meyer’s Loop Anatomy Demonstrated Using Diffusion Tensor MR Imaging and Fiber Tractography at 3T

Acta Medica Marisiensis ◽

10.2478/amma-2014-0045 ◽

2014 ◽

Vol 60 (5) ◽

pp. 215-222 ◽

Cited By ~ 1

Author(s):

Cristina Goga ◽

Zeynep Firat ◽

Klara Brinzaniuc ◽

Is Florian

Keyword(s):

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Region Of Interest ◽

Fiber Tractography ◽

Brain Images ◽

3 Dimensional ◽

Software Release ◽

Magnetic Resonance Imaging Mri ◽

Meyer’S Loop

Abstract Objective: The ultimate anatomy of the Meyer’s loop continues to elude us. Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) may be able to demonstrate, in vivo, the anatomy of the complex network of white matter fibers surrounding the Meyer’s loop and the optic radiations. This study aims at exploring the anatomy of the Meyer’s loop by using DTI and fiber tractography. Methods: Ten healthy subjects underwent magnetic resonance imaging (MRI) with DTI at 3 T. Using a region-of-interest (ROI) based diffusion tensor imaging and fiber tracking software (Release 2.6, Achieva, Philips), sequential ROI were placed to reconstruct visual fibers and neighboring projection fibers involved in the formation of Meyer’s loop. The 3-dimensional (3D) reconstructed fibers were visualized by superimposition on 3-planar MRI brain images to enhance their precise anatomical localization and relationship with other anatomical structures. Results: Several projection fiber including the optic radiation, occipitopontine/parietopontine fibers and posterior thalamic peduncle participated in the formation of Meyer’s loop. Two patterns of angulation of the Meyer’s loop were found. Conclusions: DTI with DTT provides a complimentary, in vivo, method to study the details of the anatomy of the Meyer’s loop.

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MS-2 Minimally invasive glioma surgery with navigation system and tubular retractor

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa143.009 ◽

2020 ◽

Vol 2 (Supplement_3) ◽

pp. ii2-ii3

Author(s):

Kazuhiko Kurozumi

Keyword(s):

Navigation System ◽

Diffusion Tensor ◽

Therapeutic Option ◽

Normal Brain ◽

Navigation Systems ◽

Glioma Surgery ◽

Tubular Retractor ◽

Neuronavigation System ◽

Magnetic Resonance Imaging Mri ◽

Neurological Surgery

Abstract Navigation systems are reliable and safe for neurological surgery. Navigation is an attractive and innovative therapeutic option. Recently, endo and exoscopic surgeries have been gradually increasing in neurosurgery. We are currently trialing to use 4K and 8K systems to improve the accuracy and safety of our surgical procedures. Surgeries for deep-seated tumors are challenging because of the difficulty in creating a corridor and observing the interface between lesions and the normal area. In total, 315 patients underwent surgery at Okayama University between 2017 and 2019. Among them, we experienced 92 glioma surgeries using navigation systems. Preoperatively, we performed computed tomography imaging and contrast-enhanced magnetic resonance imaging (MRI) for the neuronavigation system. We experienced Curve(TM) Image Guided Surgery (BrainLab, Munich, Germany). The surgical trajectory was planned with functional MRI and diffusion tensor imaging to protect the eloquent area and critical vasculature of the brain. We used a clear plastic tubular retractor system, the ViewSite Brain Access System, for surgery of deep seated gliomas. We gently inserted and placed the ViewSite using the neuronavigation. The tumor was observed and resected through the ViewSite tubular retractor under a microscope and endoscope. If the tumor was large, we switched the ViewSite tubular retractor to brain spatulas to identify the boundary between the normal brain and lesion. We are currently using the combination of the tubular retractor and brain spatulas using navigation system. Here, we present and analyze our preoperative simulation, surgical procedure, and outcomes.

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Preoperative identification of the facial nerve in patients with large cerebellopontine angle tumors using high-density diffusion tensor imaging

Journal of Neurosurgery ◽

10.3171/2011.12.jns111404 ◽

2012 ◽

Vol 116 (4) ◽

pp. 697-702 ◽

Cited By ~ 32

Author(s):

Neil Roundy ◽

Johnny B. Delashaw ◽

Justin S. Cetas

Keyword(s):

Diffusion Tensor Imaging ◽

Facial Nerve ◽

Cerebellopontine Angle ◽

Diffusion Tensor ◽

Tumor Resection ◽

High Density ◽

Imaging Method ◽

Study Objective ◽

Nerve Preservation ◽

Imaging Results

Object Facial nerve paresis can be a devastating complication following resection of large (> 2.5 cm) cerebellopontine angle (CPA) tumors. The authors have developed and used a new high-density diffusion tensor imaging (HD-DT imaging) method, aimed at preoperatively identifying the location and course of the facial nerve in relation to large CPA tumors. Their study objective was to preoperatively identify the facial nerve in patients with large CPA tumors and compare their HD-DT imaging method with a traditional standard DT imaging method and correlate with intraoperative findings. Methods The authors prospectively studied 5 patients with large (> 2.5 cm) CPA tumors. All patients underwent preoperative traditional standard- and HD-DT imaging. Imaging results were correlated with intraoperative findings. Results Utilizing their HD-DT imaging method, the authors positively identified the location and course of the facial nerve in all patients. In contrast, using a standard DT imaging method, the authors were unable to identify the facial nerve in 4 of the 5 patients. Conclusions The HD-DT imaging method that the authors describe and use has proven to be a powerful, accurate, and rapid method for preoperatively identifying the facial nerve in relation to large CPA tumors. Routine integration of HD-DT imaging in preoperative planning for CPA tumor resection could lead to improved facial nerve preservation.

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Increased muscle fiber fractional anisotropy value using diffusion tensor imaging after compression without fiber injury

Acta Radiologica ◽

10.1177/02841851211058282 ◽

2021 ◽

pp. 028418512110582

Author(s):

Takumi Yokohama ◽

Motoyuki Iwasaki ◽

Daisuke Oura ◽

Sho Furuya ◽

Yoshimasa Niiya

Keyword(s):

Diffusion Tensor Imaging ◽

Fractional Anisotropy ◽

Muscle Tissue ◽

Diffusion Tensor ◽

Longitudinal Direction ◽

Diffusion Parameters ◽

Apparent Diffusion ◽

The Mean ◽

Magnetic Resonance Imaging Mri ◽

Age Range

Background Recent studies have indicated that injuries such as muscle tears modify the microstructural integrity of muscle, leading to substantial alterations in measured diffusion parameters. Therefore, the fractional anisotropy (FA) value decreases. However, we hypothesized that soft tissue, such as muscle tissue, undergoes reversible changes under conditions of compression without fiber injury. Purpose To evaluate the FA change due to compression in muscle tissue without fiber injury. Material and Methods Diffusion tensor imaging (DTI) was performed on both feet of 10 healthy volunteers (mean age = 35.0 ± 10.39 years; age range = 23–52 years) using a 3.0-T magnetic resonance imaging (MRI) scanner with an eight-channel phased array knee coil. An MRI-compatible sphygmomanometer was applied to the individuals’ lower legs and individuals were placed in a compressed state. Then, rest intervals of 5 min were set in re-rest state after compression. The FA value, apparent diffusion coefficient (ADC), and eigenvalues (λ1, λ2, λ3) of the gastrocnemius and soleus muscle were measured at each state. Results The mean FA values increased in all muscles in a compressed state, while the mean λ3 decreased. In all muscles, significant differences were found between the rest and compressed states in terms of mean FA and λ3 ( P < 0.0001). Conclusion We confirmed the reversibility of the DTI metrics, which suggests that there was no muscle injury during this study. In cases of compression without fiber injury, the FA value increases, because fibers are strongly aligned in the longitudinal direction.

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