title: A Systematic Analysis of the Reliability of Diffusion Tensor Imaging Tractography for Facial Nerve Imaging in Patients with Vestibular Schwannoma.
abstract: Surgeons need to visualize the facial nerve reliably in relation to the vestibular schwannoma (VS) in surgical planning. Diffusion tensor imaging (DTI) tractography has enabled unprecedented in vivo preoperative visualization. We collected data to measure the accuracy of DTI for an accurate location of the nerve in preoperative VS resection planning. A PubMed search for relevant studies was conducted. Inclusion criteria were gross total resection of VS, preoperative DTI identification of the facial nerve, and intraoperative cranial nerve localization by the surgeon. Exclusion criteria were tumors other than VS and unsuccessful preoperative location of the cranial nerve. Accuracy rate was calculated by comparing the intraoperative and preoperative locations detailed by DTI. The query identified 38 cases of VS that fit our inclusion criteria. Overall, 89% had surgical findings that agreed with the DTI location of the facial nerve. Of these cases, 32 patients had a postoperative House-Brackmann grade I or II. Our findings suggest that DTI is a reliable method for facial nerve imaging. Implementation of this technique may help decrease facial nerve injury during surgery. Limitations and further studies are needed to better understand what factors correlate with successful location of the facial nerve and DTI in patients with VS.
authors.affiliation: Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States.
authors.forename: Nolan
authors.initials: N
authors.lastname: Ung
authors.affiliation: Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States.
authors.forename: Monica
authors.initials: M
authors.lastname: Mathur
authors.affiliation: Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States.
authors.forename: Lawrance K
authors.initials: LK
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States.
authors.forename: Nicole
authors.initials: N
authors.lastname: Cremer
authors.affiliation: Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States.
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Pelargos
authors.affiliation: Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States.
authors.forename: Andrew
authors.initials: A
authors.lastname: Frew
authors.affiliation: Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Thill
authors.affiliation: Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States.
authors.forename: Ishani
authors.initials: I
authors.lastname: Mathur
authors.affiliation: Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States.
authors.forename: Brittany
authors.initials: B
authors.lastname: Voth
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
authors.affiliation: Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, United States; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California, United States.
authors.forename: Isaac
authors.initials: I
authors.lastname: Yang
keywords: diffusion tensor imaging tractography; facial nerve; vestibular schwannoma