Intraoperative Tractography and Neuronavigation of the Pyramidal Tract(<SPECIAL ISSUE> Functional Neurophysiological Monitoring for Neurosurgery)

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Diffusion tensor imaging (DTI) based fiber tracking was applied to visualize the course of the pyramidal tract in the surgical field by microscope-based navigation. In 70 patients with lesions adjacent to the pyramidal tract, DTI data were integrated in a navigational setup. Diffusion data (b=0) were rigidly registered with standard T1-weighted 3-D images. Fiber tracking was performed applying a tensor-deflection algorithm using a multiple volume of interest approach as seed regions for tracking. fMRI data identifying the motor gyrus were applied as selection criteria to define the fibers of interest. After tracking, a 3-D object was generated representing the pyramidal tract. In selected cases, the intraoperative image data (1.5T intraoperative MRI) were used to update the navigation system. In all patients the pyramidal tract could be visualized in the operative field applying the heads-up display of the operating microscope. In 8 patients (11%) a new or aggravated postoperative paresis could be observed, which was transient in 5 of them ; thus, only in 3 patients (4.2%) was there a new permanent neurological deficit. Intraoperative imaging depicted a shifting of the pyramidal tract which amounted up to 15mm ; even the direction of shifting was variable and could not be predicted before surgery, so that mathematical models trying to predict brain shift behaviour are of restricted value only. DTI fiber tracking data can be reliably integrated into navigational systems providing intraoperative visualization of the pyramidal tract. This technique allowed the resection of lesions adjacent to the pyramidal tract with low morbidity.
2008-01-20

Intraoperative Tractography and Neuronavigation of the Pyramidal Tract(<SPECIAL ISSUE> Functional Neurophysiological Monitoring for Neurosurgery)

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