title: Outcomes of diffusion tensor tractography-integrated stereotactic radiosurgery.
abstract: OBJECTIVE
  To analyze the effect of use of tractography of the critical brain white matter fibers created from diffusion tensor magnetic resonance imaging on reduction of morbidity associated with radiosurgery.
  
  
  METHODS
  Tractography of the pyramidal tract has been integrated since February 2004 if lesions are adjacent to it, the optic radiation since May 2006, and the arcuate fasciculus since October 2007. By visually confirming the precise location of these fibers, the dose to these fiber tracts was optimized. One hundred forty-four consecutive patients with cerebral arteriovenous malformations who underwent radiosurgery with this technique between February 2004 and December 2009 were analyzed.
  
  
  RESULTS
  Tractography was prospectively integrated in 71 of 155 treatments for 144 patients. The pyramidal tract was visualized in 45, the optic radiation in 22, and the arcuate fasciculus in 13 (two tracts in 9). During the follow-up period of 3 to 72 months (median, 23 months) after the procedure, 1 patient showed permanent worsening of pre-existing dysesthesia, and another patient exhibited mild transient hemiparesis 12 months later but fully recovered after oral administration of corticosteroid agents. Two patients had transient speech disturbance before starting integration of the arcuate fasciculus tractography, but no patient thereafter.
  
  
  CONCLUSIONS
  Integrating tractography helped prevent morbidity of radiosurgery in patients with brain arteriovenous malformations.
authors.affiliation: Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan. kouga-tky@umin.ac.jp
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Koga
authors.forename: Keisuke
authors.initials: K
authors.lastname: Maruyama
authors.forename: Kyousuke
authors.initials: K
authors.lastname: Kamada
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ota
authors.forename: Masahiro
authors.initials: M
authors.lastname: Shin
authors.forename: Daisuke
authors.initials: D
authors.lastname: Itoh
authors.forename: Naoto
authors.initials: N
authors.lastname: Kunii
authors.forename: Kenji
authors.initials: K
authors.lastname: Ino
authors.forename: Atsuro
authors.initials: A
authors.lastname: Terahara
authors.forename: Shigeki
authors.initials: S
authors.lastname: Aoki
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Masutani
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Saito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000033:anatomy & histology*; D011446:Prospective Studies; D011712:Pyramidal Tracts / Q000033:anatomy & histology*; D011832:Radiation Injuries / Q000517:prevention & control*; D016634:Radiosurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D055815:Young Adult