title: Clinical use of diffusion tensor image-merged functional neuronavigation for brain tumor surgeries: review of preoperative, intraoperative, and postoperative data for 123 cases.
abstract: OBJECTIVE
  To achieve maximal safe resection during brain tumor surgery, functional image-merged neuronavigation is widely used. We retrospectively reviewed our cases in which diffusion tensor image (DTI)-merged functional neuronavigation was performed during surgery.
  
  
  METHODS
  Between November 2008 and May 2010, 123 patients underwent surgery utilizing DTI-merged neuronavigation. Anatomical magnetic resonance images (MRI) were obtained preoperatively and fused with DTI of major white matter tracts, such as the corticospinal tract, optic radiation, or arcuate fasciculus. We used this fused image for functional neuronavigation during brain tumor surgery of eloquent areas. We checked the DTI images together with postoperative MRI images and evaluated the integrity of white matter tracts.
  
  
  RESULTS
  A single white matter tract was inspected in 78 patients, and two or more white matter tracts were checked in 45 patients. Among the 123 patients, a grossly total resection was achieved in 90 patients (73.2%), subtotal resection in 29 patients (23.6%), and partial resection in 4 patients (3.3%). Postoperative neurologic outcomes, compared with preoperative function, included the following: 100 patients (81.3%) displayed improvement of neurologic symptoms or no change, 7 patients (5.7%) experienced postoperative permanent neurologic deterioration (additional or aggravated neurologic symptoms), and 16 patients (13.0%) demonstrated transient worsening.
  
  
  CONCLUSIONS
  DTI-merged functional neuronavigation could be a useful tool in brain tumor surgery for maximal safe resection. However, there are still limitations, including white matter tract shift, during surgery and in DTI itself. Further studies should be conducted to overcome these limitations.
authors.affiliation: Department of Neurosurgery, International St. Mary's Hospital, Incheon, Korea. ; Department of Medicine, Graduate School, Yonsei University, Seoul, Korea.
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Cho
authors.affiliation: Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea. ; Brain Tumor Center, Yonsei University College of Medicine, Seoul, Korea. ; Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eui Hyun
authors.initials: EH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Yonsei University College of Medicine, Seoul, Korea. ; Brain Tumor Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jinna
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Radiology, Yonsei University College of Medicine, Seoul, Korea. ; Brain Tumor Center, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung Koo
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea. ; Brain Tumor Center, Yonsei University College of Medicine, Seoul, Korea. ; Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sun Ho
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea. ; Brain Tumor Center, Yonsei University College of Medicine, Seoul, Korea. ; Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyu Sung
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea. changjh@yuhs.ac ; Brain Tumor Center, Yonsei University College of Medicine, Seoul, Korea. ; Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D056324:Diffusion Tensor Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D019635:Neurosurgical Procedures / Q000379:methods*; D011184:Postoperative Period; D057234:Preoperative Period; D012189:Retrospective Studies
keywords: Diffusion tensor image; brain tumor; navigation; tractography