Optic radiation tractography integrated into simulated treatment planning for Gamma Knife surgery.
Optic radiation tractography integrated into simulated treatment planning for Gamma Knife surgery.
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DOI：
10.3171/jns-07/10/0721
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发表时间：
2007-10
影响因子：
4.1
通讯作者：
K. Maruyama;K. Kamada;M. Shin;D. Itoh;Y. Masutani;Kenji Ino;M. Tago;N. Saito
中科院分区：
文献类型：
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作者：
K. Maruyama;K. Kamada;M. Shin;D. Itoh;Y. Masutani;Kenji Ino;M. Tago;N. Saito
目的：迄今为止，对于视放射线（OR）附近的病变，立体定向放射外科治疗后，还没有明确的预防视野缺损的方法。作者报告了将基于扩散张量（DT）磁共振成像的OR纤维束成像整合到伽玛刀手术（GKS）的模拟治疗计划中的结果。方法10例接受GKS治疗邻近手术室的动静脉畸形（AVM）的患者的影像学研究数据用于模拟治疗计划。在患者头部未被立体定向框架固定的情况下进行的弥散张量成像用于DT纤维束成像，并通过作者开发的软件可视化OR。支架固定后进行的立体定向3D成像研究的数据与DT纤维束成像的数据共同配准。将合并的图像传输到GKS治疗计划工作站。分析治疗病灶和OR之间的输送剂量和距离，并与治疗后神经系统变化相关。结果：在有视觉先兆的偏头痛或枕叶癫痫患者中，OR位于距AVM 11 mm以内。1例GKS术后出现新象限盲的患者，OR接受了32戈伊。OR的最大剂量小于12戈伊不会引起新的视野缺损。OR的最大剂量为8戈伊或更高与神经系统变化显著相关（p < 0.05），包括视野缺损和偏头痛的发展或改善。结论：将OR纤维束成像整合到GKS中是预防GKS引起的视觉障碍和头痛的一种有前途的工具。单次剂量为8戈伊或更高的照射与神经系统变化相关。
OBJECT No definitive method of preventing visual field deficits after stereotactic radiosurgery for lesions near the optic radiation (OR) has been available so far. The authors report the results of integrating OR tractography based on diffusion tensor (DT) magnetic resonance imaging into simulated treatment planning for Gamma Knife surgery (GKS). METHODS Data from imaging studies performed in 10 patients who underwent GKS for treatment of arteriovenous malformations (AVMs) located adjacent to the OR were used for the simulated treatment planning. Diffusion tensor images performed without the patient's head being secured by a stereotactic frame were used for DT tractography, and the OR was visualized by means of software developed by the authors. Data from stereotactic 3D imaging studies performed after frame fixation were coregistered with the data from DT tractography. The combined images were transferred to a GKS treatment-planning workstation. Delivered doses and distances between the treated lesions and the OR were analyzed and correlated with posttreatment neurological changes. RESULTS In patients presenting with migraine with visual aura or occipital lobe epilepsy, the OR was located within 11 mm from AVMs. In a patient who developed new quadrantanopia after GKS, the OR had received 32 Gy. A maximum dose to the OR of less than 12 Gy did not cause new visual field deficits. A maximum dose to the OR of 8 Gy or more was significantly related to neurological change (p < 0.05), including visual field deficits and development or improvement of migraine. CONCLUSIONS Integration of OR tractography into GKS represents a promising tool for preventing GKS-induced visual disturbances and headaches. Single-session irradiation at a dose of 8 Gy or more was associated with neurological change.