title: Integration of three-dimensional corticospinal tractography into treatment planning for gamma knife surgery.
abstract: OBJECTIVE
  In the radiosurgical treatment of critically located lesions, the effort to minimize the risk of complication is essential. In this study the integration of diffusion-tensor (DT) imaging-based tractography was clinically applied to treatment planning for gamma knife surgery (GKS).
  
  
  METHODS
  Seven patients with cerebral arteriovenous malformations located adjacent to the corticospinal tract (CST) underwent this technique. Data provided by DT imaging were acquired before the frame was affixed to the patient's head and the CST of the DT tractography was created using our original software. Stereotactic three-dimensional imaging studies were obtained after frame fixation and then coregistered with the data from DT tractography. After image fusion of the two studies, the combined images were transported to a GKS treatment-planning workstation. The spatial relationship between the dose distribution and the CST was clearly demonstrated within the 2 hours it took to complete the entire imaging process. The univariate logistic regression analysis of transient or permanent motor complications revealed a significant independent correlation with the volume of the CST that received 25 Gy or more and with a maximum dose to the CST (p < 0.05).
  
  
  CONCLUSIONS
  The integration of DT tractography into the GKS treatment planning was highly useful in confirming the dose to the CST during treatment planning.
authors.affiliation: Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan. kskmaru-tky@umin.ac.jp
authors.forename: Keisuke
authors.initials: K
authors.lastname: Maruyama
authors.forename: Kyousuke
authors.initials: K
authors.lastname: Kamada
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shin
authors.forename: Daisuke
authors.initials: D
authors.lastname: Itoh
authors.forename: Shigeki
authors.initials: S
authors.lastname: Aoki
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Masutani
authors.forename: Masao
authors.initials: M
authors.lastname: Tago
authors.forename: Takaaki
authors.initials: T
authors.lastname: Kirino
mesh_terms: D000328:Adult; D002648:Child; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D010347:Patient Care Planning; D011183:Postoperative Complications; D011712:Pyramidal Tracts / Q000000981:diagnostic imaging*; D011859:Radiography; D016634:Radiosurgery / Q000379:methods*; D012984:Software