Intraoperative three-dimensional visualization of the pyramidal tract in a neuronavigation system (PTV) reliably predicts true position of principal motor pathways
Intraoperative three-dimensional visualization of the pyramidal tract in a neuronavigation system (PTV) reliably predicts true position of principal motor pathways
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DOI：
10.1016/s0090-3019(03)00392-6
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发表时间：
2003-11-01
影响因子：
--
通讯作者：
Rohde, V
中科院分区：
文献类型：
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作者：
Coenen, VA;Krings, T;Rohde, V
背景这项前瞻性研究采用各向异性扩散加权（ADW）磁共振成像，在中央区域的显微神经外科手术期间将有关主要运动通路的个体空间信息整合到手术室中。我们假设基于 ADW 的神经导航系统中锥体束位置 (PTV) 的三维 (3-D) 可视化提供了有关主要运动通路的位置和延伸的有效信息。 方法 共有 13 名连续病变邻近锥体束和中心区域的患者在锥体束可视化 (PTV) 的帮助下接受了显微神经外科手术。术前获得的 ADW 序列与解剖导航序列融合。手术期间，可以在定制的神经导航系统中进行中央前回 (PG)、锥体束和肿瘤的 3D 重建。术中根据上述数据确定 PG。使用运动皮层电刺激（CS）直接验证PG位置并间接验证纤维束位置。结果11例（92%）主要运动通路位置的预测是正确的。据 PTV 报道，在一例脑膜瘤病例中，肿瘤被错误地定位在中央后部。在中央前海绵体瘤的情况下，皮层刺激不能引起运动反应。 结论 基于 ADW 的术中 PTV 为神经外科医生提供了有关颅内手术期间主要运动通路位置的可靠信息，这一点已通过术中电生理测试证明。该技术有可能降低手术发病率。 PTV 非常简单，可以适应其他定制的神经导航设备。 (C) 2003 Elsevier Inc. 保留所有权利。
BACKGROUND This prospective study employs anisotropic diffusion-weighted (ADW) magnetic resonance imaging for the integration of individual spatial information concerning the principal motor pathways into the operating room during microneurosurgery in the central region. We hypothesize that the three-dimensional (3-D) visualization of the pyramidal tract position (PTV) in a neuronavigation system based on ADW provides valid information concerning the position and extension of the principal motor pathways.METHODS A total of 13 consecutive patients with lesions adjacent to the pyramidal tracts and the central region underwent microneurosurgery with the help of pyramidal tract visualization (PTV). An ADW sequence obtained preoperatively was fused to an anatomic navigation sequence. The 3-D reconstructions of the precentral gyrus (PG), the pyramidal tract, and the tumor were available in a customized neuronavigation system during surgery. Intraoperatively the PG was identified on the basis of the aforementioned data. Electric motorcortex stimulation (CS) was used to directly verity the PG location and indirectly the fiber tract position.RESULTS In 11 cases (92%) the prediction of the principal motor pathways' position was correct. In one case of a meningioma, according to PTV, the tumor was falsely localized postcentrally. In the case of a precentral cavernoma, no motor response could be elicited by cortical stimulation.CONCLUSION Intraoperative PTV on the basis of ADW provides the neurosurgeon with reliable information concerning the position of the principal motor pathways during intracranial procedures as proved with intraoperative electrophysiological testing. The technique has the potential to reduce operative morbidity. PTV is straightforward and can be adapted to other customized neuronavigation devices. (C) 2003 Elsevier Inc. All rights reserved.