Development of the multimodal neuronavigation system integrating structural and functional information in combination with intra-operative ultrasound imaging.

点击翻译按钮获取中文摘要

The aims of this study were: 1) To improve the usefulness of neuronavigation system by integrating not only preoperative MRI but also three-dimensional (3-D) multimodal information of brain metabolism, brain functional mapping, and diffusion tensor imaging (DT1). 2) To develop a correction method for automatic brain shift of preoperative MRI data using intra-operative 3-D ultrasound.In this study, it was a significant result that the magnetoencephalography (MEG) mapping technique of language specific cortical areas had been established by using minimum L1 norm current estimate (MCE). When functional mapping data of MEG was compared with f-MRI, the comparable results were obtained in the determination of Broca area. Moreover, MEG was able to display a sequential activation of language specific areas other than Broca area in animation, and was more useful for an individual language field analysis.Furthermore, the integrating technique of diffusion tensor imaging (DTI) into neuronavigatio … More n system was developed. DTI was obtained using diffusion TENSOR Visualizer (Y Masutani, Tokyo University). For visualizing the pyramidal tracts, activated dusters from motor experiments provided one ROI to be traversed, together with the posterior horn of the internal capsule and the pyramid of the brain stem. The tracts were co-registered and overlaid on the contrast-enhanced T1-weighted images.In addition, the integrating technique of intra-operative ultrasound (US) images into neuronavigation system was developed. Real time evaluation of intra-operative brain shift became possible by overlaying preoperative MRI with US image on the neuronavigation monitor screen.Ten right-handed patients with left frontal brain tumors adjacent to Broca area underwent surgery using these technologies. 3-D information of the language area and the pyramidal tract were displayed on the screen of the neuronavigation system. After the craniotomy, but before opening the dura, one or more 3D ultrasound acquisitions were performed as the control US image. Tumor tissue was then removed, and additional US data were acquired for real time evaluation of brain shift. For resection control, a final US scan was acquired at the end of the operation so that complete removal of the tumor could be verified.From this study, it was shown that the multimodal neuronavigation system integrating structural and functional information in combination with intra-operative 3D US is a powerful tool for accurate, safe and efficient neurosurgical resections. Less