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Clinical use of diffusion tensor image-merged functional neuronavigation for brain tumor surgeries: review of preoperative, intraoperative, and postoperative data for 123 cases

 Jin Mo Cho  ;  Eui Hyun Kim  ;  Jinna Kim  ;  Seung Koo Lee  ;  Sun Ho Kim  ;  Kyu Sung Lee  ;  Jong Hee Chang 
 YONSEI MEDICAL JOURNAL, Vol.55(5) : 1303-1309, 2014 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Brain Neoplasms/pathology ; Brain Neoplasms/surgery* ; Diffusion Tensor Imaging* ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neuronavigation* ; Neurosurgical Procedures/methods* ; Postoperative Period ; Preoperative Period ; Retrospective Studies
Diffusion tensor image ; brain tumor ; navigation ; tractography
PURPOSE: To achieve maximal safe resection during brain tumor surgery, functional image-merged neuronavigation is widely used. We retrospectively reviewed our cases in which diffusion tensor image (DTI)-merged functional neuronavigation was performed during surgery. MATERIALS AND METHODS:Between November 2008 and May 2010, 123 patients underwent surgery utilizing DTI-merged neuronavigation. Anatomical magnetic resonance images (MRI) were obtained preoperatively and fused with DTI of major white matter tracts, such as the corticospinal tract, optic radiation, or arcuate fasciculus. We used this fused image for functional neuronavigation during brain tumor surgery of eloquent areas. We checked the DTI images together with postoperative MRI images and evaluated the integrity of white matter tracts. RESULTS:A single white matter tract was inspected in 78 patients, and two or more white matter tracts were checked in 45 patients. Among the 123 patients, a grossly total resection was achieved in 90 patients (73.2%), subtotal resection in 29 patients (23.6%), and partial resection in 4 patients (3.3%). Postoperative neurologic outcomes, compared with preoperative function, included the following: 100 patients (81.3%) displayed improvement of neurologic symptoms or no change, 7 patients (5.7%) experienced postoperative permanent neurologic deterioration (additional or aggravated neurologic symptoms), and 16 patients (13.0%) demonstrated transient worsening. CONCLUSION:DTI-merged functional neuronavigation could be a useful tool in brain tumor surgery for maximal safe resection. However, there are still limitations, including white matter tract shift, during surgery and in DTI itself. Further studies should be conducted to overcome these limitations.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Kim, Jinna(김진아) ORCID logo https://orcid.org/0000-0002-9978-4356
Lee, Kyu Sung(이규성)
Lee, Seung Koo(이승구) ORCID logo https://orcid.org/0000-0001-5646-4072
Chang, Jong Hee(장종희)
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