Probabilistic Tractography to Predict the Position of Cranial Nerves Displaced by Skull Base Tumors: Value for Surgical Strategy Through a Case Series of 62 Patients.
Cranial nerves
Diffusion imaging
Tractography
Tumors
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
01 07 2019
01 07 2019
Historique:
received:
19
04
2018
accepted:
14
10
2018
pubmed:
27
11
2018
medline:
25
3
2020
entrez:
27
11
2018
Statut:
ppublish
Résumé
Predicting the displacement of cranial nerves by tumors could make surgery safer and the outcome better. Recent advances in imaging and processing have overcome some of the limits associated with cranial nerve tractography, such as spatial resolution and fiber crossing. Among others, probabilistic algorithms yield to a more accurate depiction of cranial nerve trajectories. To report how cranial nerve probabilistic tractography can help the surgical strategy in a series of various skull base tumors. After distortion correction and region of interest seeding, a probabilistic tractography algorithm used the constrained spherical deconvolution model and attempted the reconstruction of cranial nerve trajectories in both healthy and displaced conditions. Sixty-two patients were included and presented: vestibular schwannomas (n = 33); cerebellopontine angle meningiomas (n = 15); arachnoid or epidermoid cysts (n = 6); cavernous sinus and lower nerves schwannomas (n = 4); and other tumors (n = 4). For each patient, at least one 'displaced' cranial nerve was not clearly identified on classical anatomical MRI images. All 372 cranial nerves were successfully tracked on each healthy side; among the 175 cranial nerves considered 'displaced' by tumors, 152 (87%) were successfully tracked. Among the 127 displaced nerves of operated patients (n = 51), their position was confirmed intraoperatively for 118 (93%) of them. Conditions that led to tractography failure were detailed. On the basis of tractography, the surgical strategy was adjusted for 44 patients (71%). This study reports a cranial nerve probabilistic tractography pipeline that can: predict the position of most cranial nerves displaced by skull base tumors, help the surgical strategy, and thus be a pertinent tool for future routine clinical application.
Sections du résumé
BACKGROUND
Predicting the displacement of cranial nerves by tumors could make surgery safer and the outcome better. Recent advances in imaging and processing have overcome some of the limits associated with cranial nerve tractography, such as spatial resolution and fiber crossing. Among others, probabilistic algorithms yield to a more accurate depiction of cranial nerve trajectories.
OBJECTIVE
To report how cranial nerve probabilistic tractography can help the surgical strategy in a series of various skull base tumors.
METHODS
After distortion correction and region of interest seeding, a probabilistic tractography algorithm used the constrained spherical deconvolution model and attempted the reconstruction of cranial nerve trajectories in both healthy and displaced conditions.
RESULTS
Sixty-two patients were included and presented: vestibular schwannomas (n = 33); cerebellopontine angle meningiomas (n = 15); arachnoid or epidermoid cysts (n = 6); cavernous sinus and lower nerves schwannomas (n = 4); and other tumors (n = 4). For each patient, at least one 'displaced' cranial nerve was not clearly identified on classical anatomical MRI images. All 372 cranial nerves were successfully tracked on each healthy side; among the 175 cranial nerves considered 'displaced' by tumors, 152 (87%) were successfully tracked. Among the 127 displaced nerves of operated patients (n = 51), their position was confirmed intraoperatively for 118 (93%) of them. Conditions that led to tractography failure were detailed. On the basis of tractography, the surgical strategy was adjusted for 44 patients (71%).
CONCLUSION
This study reports a cranial nerve probabilistic tractography pipeline that can: predict the position of most cranial nerves displaced by skull base tumors, help the surgical strategy, and thus be a pertinent tool for future routine clinical application.
Identifiants
pubmed: 30476219
pii: 5209703
doi: 10.1093/neuros/nyy538
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E125-E136Informations de copyright
Copyright © 2018 by the Congress of Neurological Surgeons.