intraoperative neuronavigation using diffusion tensor MR tractography for the resection of a deep tumor adjacent to the corticospinal tract.
OBJECTIVE
Delineation of cerebral white matter tracts using MR tractography adds essential information for planning intracranial surgery. Integrating tractography with intraoperative neuronavigation may reduce the likelihood of new neurological deficits after surgery done to remove tumors adjacent to the projection fibers of eloquent cortex. We report the utility of such integration for the resection of deep (paraventricular) tumors.


METHODS
A 67-year-old male with malignant melanoma underwent stereotactic radiosurgery for a single metastasis within the paraventricular white matter of the right frontal lobe near the corticospinal tract. The lesion doubled in size within 12 months of radiotherapy. Surgical extirpation was performed aided by intraoperative neuronavigation.


METHODS
MR images of the brain including MR tractography and post-contrast T1-weighted sequences were acquired and imported into a neuronavigational workstation. Asymmetric fusion of contrast-enhanced images and tractography was employed to assist in preservation of the integrity of critical white matter tracts during the surgical procedure.


CONCLUSIONS
Inclusion of tractography in standard imaging protocols for neuronavigational systems may increase the safety of neurosurgical intervention near white matter tracts, including deep areas adjacent to the ventricles.
Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. imccutch@mdanderson.org
Roman
R
Hlatky
Edward F
EF
Jackson
Jeffrey S
JS
Weinberg
Ian E
IE
McCutcheon
D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D038361:Neuronavigation / Q000379:methods*; D019635:Neurosurgical Procedures; D011712:Pyramidal Tracts / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods