Artikel
Individual 3D fibre tract atlas of the brain stem on the basis of DWI for microneurosurgery of brain stem cavernomas
Individuelle 3D-Faserbahn-Atlanten des Hirnstammes auf Basis der DWI zur Planung der mikroneurochirurgischen Entfernung von Hirnstamm-Kavernomen
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
To investigate the potential of an individual fiber tract atlas of the human brain stem on the basis of diffusion weighted imaging (DWI) compared to a histologically derived atlas in predicting large fiber tract involvement in patients with brain stem lesions during microneurosurgical removal.
Methods
Two patients (m 17 y, f 40 y) with symptomatic cavernomas of the brain stem were operated with the presented technique. Preoperatively both underwent DWI imaging and T1W high resolution 3D anatomical sequences. After fusion of both sequences, the lesions and the principle motor pathways were segmented interactively and reconstructed three-dimensionally. As a comparison, a new fibre tract atlas of the brainstem was utilized. Serial histological sections of one cadaver human brainstem were used to derive fibre orientation maps by analysis of polarized light sequences of these sections which gives information about angles of fibre inclination and angles of fibre direction. In the resulting 3D data set, major fibre tracts were segmented using the software tool 3D Slicer (Gering 1999, USA).
Results
In one patient, the cavernoma displaced the pyramidal tract anteriorly at the level of the upper pons. The histologically derived atlas was not able to predict the fiber tract position as the individual DWI derived atlas could. The lesion was removed via a lateral suboccipital retrosigmoidal approach and the clinical status remained unchanged. In the other patient the cavernoma led to an anterior and lateral displacement of the pyramidal tract at the level of the lower pons. Again, the histologically derived atlas data was not able to predict this fibre tract position. The lesion was removed through the brachium pontis preserving an unchanged neurological status.
Conclusions
The individual fiber tract atlas obtained by DWI data convey important additional information on fibre tracts’ positions during microneurosurgical removal of brain stem lesions. From our limited experience with this technique, we conclude that this individualized information is superior to normal probabilistic anatomical atlas data.