scholarly journals Constrained-Spherical Deconvolution Tractography in the Evaluation of the Corticospinal Tract in Glioma Surgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhiyuan Sheng ◽  
Jinliang Yu ◽  
Zhongcan Chen ◽  
Yong Sun ◽  
Xingyao Bu ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Corticospinal Tract ◽  
Mean Diffusivity ◽  
Motor Deficit ◽  
Precentral Gyrus ◽  
Glioma Surgery ◽  
Constrained Spherical Deconvolution ◽  
Spherical Deconvolution ◽  
Before And After ◽  
Deterministic Tractography

Introduction: Tractography has demonstrated utility for surgical resection in the setting of primary brain tumors involving eloquent white matter (WM) pathways.Methods: Twelve patients with glioma in or near eloquent motor areas were analyzed. The motor status was recorded before and after surgery. Two different tractography approaches were used to generate the motor corticospinal tract (CST): Constrained spherical deconvolution probabilistic tractography (CSD-Prob) and single tensor deterministic tractography (Tens-DET). To define the degree of disruption of the CST after surgical resection of the tumor, we calculated the percentage of the CST affected by surgical resection, which was then correlated with the postoperative motor status. Moreover, the fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) of the CST generated by the CSD-Prob and the Tens-DET was measured and compared between the ipsilesional and contralesional side.Results: The CST was identified in all patients and its trajectory was displaced by the tumor. Only the CSD-Prob approach showed the CST with the characteristic fan-like projections from the precentral gyrus to the brainstem. Disruption of the CST was identified in 6/6 with postoperative motor deficit by CSD-Prob approach and in 5/6 in the Tens-DET. The degree of disruption was significantly associated with the motor deficit with the CSD-Prob approach (rho = −0.88, p = 0.021). However, with the Tens-DET approach the CST disruption did not show significant association with the motor function (rho = −0.27, p = 0.6). There was a significant decrease in FA (p = 0.006) and a significant increase in MD (p = 0.0004) and RD (p = 0.005) on the ipsilesional CST compared with the contralesional CST only with the CSD-Prob approach.Conclusion: CSD-Prob accurately represented the known anatomy of the CST and provided a meaningful estimate of microstructural changes of the CST affected by the tumor and its macrostructural damage after surgery. Newer surgical planning stations should include advanced models and algorithms of tractography in order to obtain more meaningful reconstructions of the WM pathways during glioma surgery.

Intraoperative Motor Evoked Potential Alteration in Intracranial Tumor Surgery and Its Relation to Signal Alteration in Postoperative Magnetic Resonance Imaging

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 302-313 ◽  
Author(s):  
Andrea Szelényi ◽  
Elke Hattingen ◽  
Stefan Weidauer ◽  
Volker Seifert ◽  
Ulf Ziemann
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Motor Cortex ◽  
Evoked Potential ◽  
Corticospinal Tract ◽  
Motor Evoked Potential ◽  
Motor Deficit ◽  
Warning Sign ◽  
Precentral Gyrus ◽  
Resonance Imaging

Abstract OBJECTIVE To determine the degree to which the pattern of intraoperative isolated, unilateral alteration of motor evoked potential (MEP) in intracranial surgery was related to motor outcome and location of new postoperative signal alterations on magnetic resonance imaging (MRI). METHODS In 29 patients (age, 42.8 ± 18.2 years; 15 female patients; 25 supratentorial, 4 infratentorial procedures), intraoperative MEP alterations in isolation (without significant alteration in other evoked potential modalities) were classified as deterioration (> 50% amplitude decrease and/or motor threshold increase) or loss, respectively, or reversible and irreversible. Postoperative MRI was described for the location and type of new signal alteration. RESULTS New motor deficit was present in all 5 patients with irreversible MEP loss, in 7 of 10 patients with irreversible MEP deterioration, in 1 of 6 patients with reversible MEP loss, and in 0 of 8 patients with reversible MEP deterioration. Irreversible compared with reversible MEP alteration was significantly more often correlated with postoperative motor deficit (P < .0001). In 20 patients, 22 new signal alterations affected 29 various locations (precentral gyrus, n = 5; corticospinal tract, n = 19). Irreversible MEP alteration was more often associated with postoperative new signal alteration in MRI compared with reversible MEP alteration (P = .02). MEP loss was significantly more often associated with subcortically located new signal alteration (P = .006). MEP deterioration was significantly more often followed by new signal alterations located in the precentral gyrus (P = .04). CONCLUSION MEP loss bears a higher risk than MEP deterioration for postoperative motor deficit resulting from subcortical postoperative MR changes in the corticospinal tract. In contrast, MEP deterioration points to motor cortex lesion. Thus, even MEP deterioration should be considered a warning sign if surgery close to the motor cortex is performed.

scholarly journals STMO-03 Surgical resection for precentral gyrus glioma

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii10-ii10
Author(s):  
Noriyuki Kijima ◽  
Manabu Kinoshita ◽  
Ryuichi Hirayama ◽  
Naoki Kagawa ◽  
Haruhiko Kishima
Keyword(s):  
Motor Cortex ◽  
Surgical Resection ◽  
Primary Motor Cortex ◽  
Neurological Complication ◽  
Extent Of Resection ◽  
Awake Surgery ◽  
Motor Deficit ◽  
Precentral Gyrus ◽  
Grade Ii ◽  
Grade Iii

Abstract Primary motor cortex glioma is usually considered unresectable because of its high risk for motor deficit. However, recent reports suggest that surgical resection for primary motor cortex brain tumor is feasible for selected patients. In this study, we analyzed the neurological outcomes for 27 patients who underwent surgical resections for precentral gyrus glioma. Glioma grades for 27 patients were Grade II in 6 cases, Grade III in 7 cases, and Grade IV in 13 cases. 11 patients were recurrent glioma cases and glioma grade for those patients were Grade II in 4 cases, Grade III in 3 cases, and Grade IV in 4 cases. Extent of resection for 27 patients was biopsy in 2 cases, partial resection in 16 cases, and more than 90% of resections in 9 cases. 6 patients underwent awake surgery and glioma grade for those patients were Grade II in 3 cases, Grade III in 2 cases, and Grade IV in 1 case. Median extent of resection for patients who underwent awake surgery was 90%. Transient neurological worsening was observed in 5 patients, however, no patient exhibited permanent neurological deficit. Surgical resections for primary motor cortex glioma were feasible in selected patients without severe neurological complication. Careful intraoperative awake mapping is desirable to achieve maximum resections.

scholarly journals Insular gliomas and tractographic visualization of the connectome

2022 ◽  
Vol 6 (1) ◽  
pp. V4
Keyword(s):  
Artificial Intelligence ◽  
White Matter ◽  
Surgical Resection ◽  
Brain Mapping ◽  
Image Guidance ◽  
Constrained Spherical Deconvolution ◽  
Spherical Deconvolution ◽  
Brain Connectome ◽  
Mapping Software ◽  
Cortical Regions

In this video, the authors present a connectome-guided surgical resection of an insular glioma in a 39-year-old woman. Preoperative study with constrained spherical deconvolution (CSD)–based tractography revealed the surrounding brain connectome architecture around the tumor relevant for safe surgical resection. Connectomic information provided detailed maps of the surrounding language and salience networks, including eloquent white matter fibers and cortical regions, which were visualized intraoperatively with image guidance and artificial intelligence (AI)–based brain mapping software. Microsurgical dissection is presented with detailed discussion of the safe boundaries and angles of resection when entering the insular operculum defined by connectomic information. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21194

scholarly journals Effects of Piano Training in Unilateral Cerebral Palsy Using Probabilistic and Deterministic Tractography: A Case Report

2021 ◽  
Vol 15 ◽  
Author(s):  
Ana Alves-Pinto ◽  
Mónica Emch ◽  
Renée Lampe
Keyword(s):  
Cerebral Palsy ◽  
Fractional Anisotropy ◽  
Corticospinal Tract ◽  
Single Case ◽  
Mean Diffusivity ◽  
User Input ◽  
Neuronal Processes ◽  
Deterministic Tractography ◽  
The Right ◽  
Post Hoc

Cerebral palsy (CP) is an umbrella term encompassing motor and often additional disabilities, resulting from insult to the developing brain and remaining throughout life. Imaging-detected alterations in white matter microstructure affect not only motor but also sensorimotor pathways. In this context, piano training is believed to promote sensorimotor rehabilitation for the multiplicity of skills and neuronal processes it involves and integrates. However, it remains unknown how this contribution may occur. Here, effects of 1.5 years of piano training in an adolescent with unilateral CP were investigated through tests of manual function and by comparing fractional anisotropy, mean diffusivity, radial and axial diffusivity in neuronal pathways pre- vs. post-training. In the absence of a control condition and of data from a larger cohort, both probabilistic neighborhood and deterministic tractography were employed to reduce bias associated with a single-case analysis and/or with user-input. No changes in manual function were detected with the tests performed. In turn, the two tractography methods yielded similar values for all studied metrics. Furthermore, post-hoc analyses yielded increased fractional anisotropy accompanied by decreases in mean diffusivity in the bilateral dorsal cingulate that were at least as large as and more consistent than in the bilateral corticospinal tract. This suggests contributions of training to the development of non-motor processes. Reduced anisotropy and correspondingly high mean diffusivity were observed for the bilateral corticospinal tract as well as for the right arcuate and the inferior longitudinal fasciculus, two sensory processing-related pathways, confirming the importance of sensorimotor rehabilitation in CP.

scholarly journals Risk stratification in motor area–related glioma surgery based on navigated transcranial magnetic stimulation data

2017 ◽  
Vol 126 (4) ◽  
pp. 1227-1237 ◽  
Author(s):  
Tizian Rosenstock ◽  
Ulrike Grittner ◽  
Güliz Acker ◽  
Vera Schwarzer ◽  
Nataliia Kulchytska ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Risk Stratification ◽  
Magnetic Stimulation ◽  
Motor Deficit ◽  
Precentral Gyrus ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Glioma Surgery ◽  
Risk Stratification Model ◽  
Resting Motor Threshold ◽  
Motor Outcome

OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) is a noninvasive method for preoperatively localizing functional areas in patients with tumors in presumed motor eloquent areas. The aim of this study was to establish an nTMS-based risk stratification model by examining whether the results of nTMS mapping and its neurophysiological data predict postoperative motor outcome in glioma surgery. METHODS Included in this study were prospectively collected data for 113 patients undergoing bihemispheric nTMS examination prior to surgery for gliomas in presumed motor eloquent locations. Multiple ordinal logistic regression analysis was performed to test for any association between preoperative nTMS-related variables and postoperative motor outcome. RESULTS A new motor deficit or deterioration due to a preexisting deficit was observed in 20% of cases after 7 days and in 22% after 3 months. In terms of tumor location, no new permanent deficit was observed when the distance between tumor and corticospinal tract was greater than 8 mm and the precentral gyrus was not infiltrated (p = 0.014). New postoperative deficits on Day 7 were associated with a pathological excitability of the motor cortices (interhemispheric resting motor threshold [RMT] ratio < 90% or > 110%, p = 0.031). Interestingly, motor function never improved when the RMT was significantly higher in the tumorous hemisphere than in the healthy hemisphere (RMT ratio > 110%). CONCLUSIONS The proposed risk stratification model, based on objective functional-anatomical and neurophysiological measures, enables one to counsel patients about the risk of functional deterioration or the potential for recovery.

scholarly journals Long-term motor deficit in brain tumour surgery with preserved intra-operative motor-evoked potentials

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Davide Giampiccolo ◽  
Cristiano Parisi ◽  
Pietro Meneghelli ◽  
Vincenzo Tramontano ◽  
Federica Basaldella ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Brain Tumour ◽  
Evoked Potential ◽  
Corticospinal Tract ◽  
Motor Evoked Potentials ◽  
Motor Evoked Potential ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Brain Tumour Surgery

Abstract Muscle motor-evoked potentials are commonly monitored during brain tumour surgery in motor areas, as these are assumed to reflect the integrity of descending motor pathways, including the corticospinal tract. However, while the loss of muscle motor-evoked potentials at the end of surgery is associated with long-term motor deficits (muscle motor-evoked potential-related deficits), there is increasing evidence that motor deficit can occur despite no change in muscle motor-evoked potentials (muscle motor-evoked potential-unrelated deficits), particularly after surgery of non-primary regions involved in motor control. In this study, we aimed to investigate the incidence of muscle motor-evoked potential-unrelated deficits and to identify the associated brain regions. We retrospectively reviewed 125 consecutive patients who underwent surgery for peri-Rolandic lesions using intra-operative neurophysiological monitoring. Intraoperative changes in muscle motor-evoked potentials were correlated with motor outcome, assessed by the Medical Research Council scale. We performed voxel–lesion–symptom mapping to identify which resected regions were associated with short- and long-term muscle motor-evoked potential-associated motor deficits. Muscle motor-evoked potentials reductions significantly predicted long-term motor deficits. However, in more than half of the patients who experienced long-term deficits (12/22 patients), no muscle motor-evoked potential reduction was reported during surgery. Lesion analysis showed that muscle motor-evoked potential-related long-term motor deficits were associated with direct or ischaemic damage to the corticospinal tract, whereas muscle motor-evoked potential-unrelated deficits occurred when supplementary motor areas were resected in conjunction with dorsal premotor regions and the anterior cingulate. Our results indicate that long-term motor deficits unrelated to the corticospinal tract can occur more often than currently reported. As these deficits cannot be predicted by muscle motor-evoked potentials, a combination of awake and/or novel asleep techniques other than muscle motor-evoked potentials monitoring should be implemented.

scholarly journals Clinical features and outcomes of combined hepatocellular carcinoma and cholangiocarcinoma versus hepatocellular carcinoma versus cholangiocarcinoma after surgical resection: a propensity score matching analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chih-Wen Lin ◽  
Tsung-Chin Wu ◽  
Hung-Yu Lin ◽  
Chao-Ming Hung ◽  
Pei-Min Hsieh ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Surgical Resection ◽  
Disease Free Survival ◽  
Clinicopathological Features ◽  
Free Survival ◽  
Before And After ◽  
Disease Free

Abstract Background Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is an infrequent type of primary liver cancer that comprises hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC). This study investigated the clinicopathological features and prognosis among cHCC-CC, HCC, and CC groups. Methods We prospectively collected the data of 608 patients who underwent surgical resection for liver cancer between 2011 and 2018 at E-Da Hospital, I-Shou University, Kaohsiung, Taiwan. Overall, 505 patients with cHCC-CC, HCC, and CC were included, and their clinicopathological features, overall survival (OS), and recurrence were recorded. OS and recurrence rates were analyzed using the Kaplan–Meier analysis. Results In the entire cohort, the median age was 61 years and 80% were men. Thirty-five (7.0%) had cHCC-CC, 419 (82.9%) had HCC, and 51 (10.1%) had CC. The clinicopathological features of the cHCC-CC group were more identical to those of the HCC group than the CC group. OS was significantly lower in the cHCC-CC group than in the HCC group but was not significantly higher in the cHCC-CC group than in the CC group. The median OS of cHCC-CC, HCC, and CC groups was 50.1 months [95% confidence interval (CI): 38.7–61.2], 62.3 months (CI: 42.1–72.9), and 36.2 months (CI: 15.4–56.5), respectively. Cumulative OS rates at 1, 3, and 5 years in cHCC-CC, HCC, and CC groups were 88.5%, 62.2%, and 44.0%; 91.2%, 76.1%, and 68.0%; and 72.0%, 48.1%, and 34.5%, respectively. After propensity score matching (PSM), OS in the cHCC-CC group was not significantly different from that in the HCC or CC group. However, OS was significantly higher in the HCC group than in the CC group before and after PSM. Furthermore, the disease-free survival was not significantly different among cHCC-CC, HCC, and CC groups before and after PSM. Conclusion The clinicopathological features of the cHCC-CC group were more identical to those of the HCC group than the CC group. The OS rate was significantly lower in the cHCC-CC group than the HCC group. However, after PSM, OS and disease-free survival in the cHCC-CC group were not significantly different from those in the HCC or CC group.

Neurophysiologic Mapping of Thalamocortical Tract in Asleep Craniotomies: Promising Results From an Early Experience

2020 ◽  
Author(s):  
Mirela V Simon ◽  
Daniel K Lee ◽  
Bryan D Choi ◽  
Pratik A Talati ◽  
Jimmy C Yang ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Corticospinal Tract ◽  
Sensory Function ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Central Sulcus ◽  
Postcentral Gyrus ◽  
Subcortical Stimulation ◽  
Subcortical Mapping

Abstract BACKGROUND Subcortical mapping of the corticospinal tract has been extensively used during craniotomies under general anesthesia to achieve maximal resection while avoiding postoperative motor deficits. To our knowledge, similar methods to map the thalamocortical tract (TCT) have not yet been developed. OBJECTIVE To describe a neurophysiologic technique for TCT identification in 2 patients who underwent resection of frontoparietal lesions. METHODS The central sulcus (CS) was identified using the somatosensory evoked potentials (SSEP) phase reversal technique. Furthermore, monitoring of the cortical postcentral N20 and precentral P22 potentials was performed during resection. Subcortical electrical stimulation in the resection cavity was done using the multipulse train (case #1) and Penfield (case #2) techniques. RESULTS Subcortical stimulation within the postcentral gyrus (case #1) and in depth of the CS (case #2), resulted in a sudden drop in amplitudes in N20 (case #1) and P22 (case #2), respectively. In both patients, the potentials promptly recovered once the stimulation was stopped. These results led to redirection of the surgical plane with avoidance of damage of thalamocortical input to the primary somatosensory (case #1) and motor regions (case #2). At the end of the resection, there were no significant changes in the median SSEP. Both patients had no new long-term postoperative sensory or motor deficit. CONCLUSION This method allows identification of TCT in craniotomies under general anesthesia. Such input is essential not only for preservation of sensory function but also for feedback modulation of motor activity.

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