Relative anterior safe area for invasive procedures in the human brain: diffusion tensor tractography.
OBJECTIVE
Many interventions, including surgery, procedures of shunt operation, or radiotherapy could result in neural injury of the brain. However, research to prevent or minimize injury of neural tracts has been overlooked.


METHODS
We recruited 41 healthy subjects. Diffusion tensor images were acquired and five neural tracts were reconstructed (corticospinal tract, corticoreticular pathway, arcuate fasciculus, cingulum, and superior longitudinal fasciculus). We defined the safe area, which is an area free from any trajectory of five neural tracts: the medial boundary - the most lateral point free from any trajectory of five neural tracts, the posterior boundary - the most anterior point free from any trajectory of five neural tracts.


RESULTS
Medial boundaries of the safe area in the cortex, centrum semiovale, corona radiata, and internal capsule were located at an average of 0 mm, 12.28 mm, 12.43 mm, and 10.34 mm laterally from the midline, respectively, and the posterior boundaries were located at an average of 1.30 mm, 4.26 mm, 7.05 mm, and 5.74 mm from the ACL, respectively. In addition, we found that the common safe areas for all four axial levels were located at 13.44 mm (medial boundary) and 9.35 mm (posterior boundary).


CONCLUSIONS
We identified a relatively safe area for the performance of invasive procedures in the anterior portion of the human brain.
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University , Daegu , Republic of Korea.
Sung Ho
SH
Jang
Hyeok Gyu
HG
Kwon
D000328:Adult; D001921:Brain / Q000033:anatomy & histology* / Q000601:surgery; D001930:Brain Injuries / Q000517:prevention & control; D001931:Brain Mapping / Q000379:methods*; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D055815:Young Adult
Invasive procedures; diffusion tensor tractography; external ventricular drainage; safe area