title: Intraoperative visualization of fiber tracking based reconstruction of language pathways in glioma surgery.
abstract: BACKGROUND
  For neuroepithelial tumors, the surgical goal is maximum resection with preservation of neurological function. This is contributed to by intraoperative magnetic resonance imaging (iMRI) combined with multimodal navigation.
  
  
  OBJECTIVE
  We evaluated the contribution of diffusion tensor imaging (DTI)-based fiber tracking of language pathways with 2 different algorithms (tensor deflection, connectivity analysis [CA]) integrated in the navigation on the surgical outcome.
  
  
  METHODS
  We evaluated 32 patients with neuroepithelial tumors who underwent surgery with DTI-based fiber tracking of language pathways integrated in neuronavigation. The tensor deflection algorithm was routinely used and its results intraoperatively displayed in all cases. The CA algorithm was furthermore evaluated in 23 cases. Volumetric assessment was performed in pre- and intraoperative MR images. To evaluate the benefit of fiber tractography, language deficits were evaluated pre- and postoperatively and compared with the volumetric analysis.
  
  
  RESULTS
  Final gross-total resection was performed in 40.6% of patients. Absolute tumor volume was reduced from 55.33 ± 63.77 cm(3) to 20.61 ± 21.67 cm(3) in first iMRI resection control, to finally 11.56 ± 21.92 cm(3) (P < .01). Fiber tracking of the 2 algorithms showed a deviation of the displayed 3D objects by <5 mm. In long-term follow-up only 1 patient (3.1%) had a persistent language deficit.
  
  
  CONCLUSIONS
  Intraoperative visualization of language-related cortical areas and the connecting pathways with DTI-based fiber tracking can be successfully performed and integrated in the navigation system. In a setting of intraoperative high-field MRI this contributes to maximum tumor resection with low postoperative morbidity.
authors.affiliation: Department of Neurosurgery, University of Marburg, Marburg, Germany. kuhntd@med.uni-marburg.de
authors.forename: Daniela
authors.initials: D
authors.lastname: Kuhnt
authors.forename: Miriam H A
authors.initials: MH
authors.lastname: Bauer
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.forename: Dorit
authors.initials: D
authors.lastname: Merhof
authors.forename: Amir
authors.initials: A
authors.lastname: Zolal
authors.forename: Mirco
authors.initials: M
authors.lastname: Richter
authors.forename: Peter
authors.initials: P
authors.lastname: Grummich
authors.forename: Oliver
authors.initials: O
authors.lastname: Ganslandt
authors.forename: Michael
authors.initials: M
authors.lastname: Buchfelder
authors.forename: Christopher
authors.initials: C
authors.lastname: Nimsky
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001932:Brain Neoplasms / Q000601:surgery*; D056324:Diffusion Tensor Imaging; D005260:Female; D005910:Glioma / Q000601:surgery*; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009434:Neural Pathways; D038361:Neuronavigation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D055815:Young Adult