Arcuate fasciculus tractography integrated into Gamma Knife surgery.
Arcuate fasciculus tractography integrated into Gamma Knife surgery.
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DOI：
10.3171/2008.4.17521
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发表时间：
2009-09
影响因子：
4.1
通讯作者：
K. Maruyama;Tomoyuki Koga;K. Kamada;T. Ota;D. Itoh;Kenji Ino;H. Igaki;S. Aoki;Y. Masutani;M. Shin;N. Saito
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文献类型：
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作者：
K. Maruyama;Tomoyuki Koga;K. Kamada;T. Ota;D. Itoh;Kenji Ino;H. Igaki;S. Aoki;Y. Masutani;M. Shin;N. Saito
目的为预防伽玛刀手术（GKS）后的语言障碍，作者将基于弥散张量（DT） MR成像的弓状束（AF）束造影纳入GKS的治疗计划。方法回顾性地将弓状束束造影纳入以前由神经外科医生和放射肿瘤学家进行的计划。该技术回顾性应用于12例心房颤动附近动静脉畸形患者。在将框架固定在患者头部之前获得弥散张量图像，并使用作者的原始软件创建心房颤动的DT束图图像。将框架固定后获得的DT束造影和立体定向3D成像研究数据传输到GKS治疗计划工作站并共同登记，以便评估给药剂量和治疗后失语的发生率。结果2例以动静脉畸形出血引起的运动失语为首发表现的AF患者未出现房颤。在GKS后29个月的中位随访期间，2例患者出现失语，其中30 Gy照射心房额部导致传导性失语1例，9.6 Gy照射颞部导致运动性失语1例。4例患者额叶纤维最大辐射剂量为10.0 ~ 16.8 Gy， 3例患者颞叶纤维最大辐射剂量为3.6 ~ 5.2 Gy，未见言语功能障碍。结论：作者发现，在GKS过程中，10 gy的辐射剂量在AF的额叶纤维中是耐受的，而在颞叶纤维中则不耐受。作者建议通过结合AF束造影和GKS来确认剂量，特别是在颞叶语言纤维附近的病变中。
OBJECT To prevent speech disturbances after Gamma Knife surgery (GKS), the authors integrated arcuate fasciculus (AF) tractography based on diffusion tensor (DT) MR imaging into treatment planning for GKS. METHODS Arcuate fasciculus tractography was retrospectively integrated into planning that had been previously performed by neurosurgeons and radiation oncologists. This technique was retrospectively applied to 12 patients with arteriovenous malformations adjacent to the AF. Diffusion tensor images were acquired before the frame was affixed to the patient's head and DT tractography images of the AF were created using the authors' original software. The data from DT tractography and stereotactic 3D imaging studies obtained after frame fixation were transported to a treatment planning workstation for GKS and coregistered so that the delivered doses and incidence of posttreatment aphasia could be assessed. RESULTS The AF could not be depicted in 2 patients who initially presented with motor aphasia caused by hemorrhaging from arteriovenous malformations. During the median follow-up period of 29 months after GKS, aphasia developed in 2 patients: 30 Gy delivered to the frontal portion of the AF caused conduction aphasia in 1 patient, and 9.6 Gy to the temporal portion led to motor aphasia in the other. Speech dysfunction was not observed after a maximum radiation dose of 10.0-16.8 Gy was delivered to the frontal fibers in 4 patients, and 3.6-5.2 Gy to the temporal fibers in 3. CONCLUSIONS The authors found that administration of a 10-Gy radiation dose during GKS was tolerated in the frontal but not the temporal fibers of the AF. The authors recommend confirmation of the dose by integration of AF tractography with GKS, especially in lesions located near the temporal language fibers.