Combined use of tractography-integrated functional neuronavigation and direct fiber stimulation
Combined use of tractography-integrated functional neuronavigation and direct fiber stimulation
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DOI：
10.3171/jns.2005.102.4.0664
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发表时间：
2005-04-01
影响因子：
4.1
通讯作者：
Morita, A
中科院分区：
文献类型：
--
作者：
Kamada, K;Todo, T;Morita, A
物体。这项研究的目的是通过将基于扩散张量(DT)成像的气管造影术结果与解剖三维磁共振图像准确地配准，并随后将组合图像输入神经导航系统(功能性神经导航)，更好地进行术前规划并直接应用于术中操作。对6例邻近皮质脊髓束(CST)的脑部病变进行了研究。在手术中，使用直接纤维刺激来唤起运动反应，以确认功能性神经导航所描绘的CST的准确性。在三名患者中，刺激假设的CST诱发了预期的运动诱发电位。在其他三组中，在距离假定的CST超过1厘米的切除边界上的刺激没有显示任何运动反应。所有患者均接受了适当的肿瘤切除，保留了CST。将基于DT成像的气管造影术信息整合到传统的神经导航系统中，显示了病变与CST之间的空间关系，从而在病变切除过程中避免了束损伤。直接纤维刺激用于实时可靠的白质映射，用于调整神经导航系统数据和大脑结构潜在位置变化之间的任何差异。这些技术的结合使作者能够在手术中确定CST的准确位置，并实现最佳的肿瘤切除。
Object. The aim of this study was better preoperative planning and direct application to intraoperative procedures through accurate coregistration of diffusion-tensor (DT) imaging-based tractography results and anatomical three-dimensional magnetic resonance images and subsequent importation of the combined images to a neuronavigation system (functional neuronavigation).Methods. Six patients with brain lesions adjacent to the corticospinal tract (CST) were studied. During surgery, direct fiber stimulation was used to evoke motor responses to confirm the accuracy of CST depicted on functional neuronavigation. In three patients, Stimulation of the supposed CST elicited the expected motor evoked potentials. In the other three, stimulation at the resection borders more than 1 cm away from the supposed CST showed no motor response. All patients underwent appropriate tumor resection with preservation of the CST.Conclusions. Integration of the DT imaging-based tractography information into a traditional neuronavigation system demonstrated spatial relationships between lesions and the CST, allowing for the avoidance of tract injury during lesion resection. Direct fiber stimulation was used for real-time reliable white matter mapping, which served to adjust for any discrepancy between the neuronavigation system data and potentially shifted positions of the brain structures. The combination of these techniques enabled the authors to identify accurate positions of the CST during surgery and to accomplish optimal tumor resections.