Usefulness of Leksell GammaPlan for tumor treatment - cranial nerve delineation and fusion of neuroimaging including DTI -

Manabu Tamura1, Yoshiyuki Konishi2, Noriko Tamura1, Naoyuki Nakao3, Uematsu Yuji3, Toru Itakura3, Jean Regis4, Motohiro Hayashi1, Yoshihiro Muragaki2, Hiroshi Iseki2

1Tokyo, Japan 2Institute of Advanced Biomedical Engineering and Science, TWMU 3Department of Neurological Surgery, Wakayama Medical University 4

Keywords: dose planning, brain tumor, gamma knife, cranial nerve, Imaging

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Abstract

     We use the application ‘Leksell GammaPlan (LGP)’ for tumor surgery as well as Gamma Kinfe surgery (GKS). Practical investigations of the topics (cranial nerve delineation and brain mapping) and preliminary reports as to DTI fusion for GKS are evaluated.
     Our purpose was to study various imaging tools for radiosurgery planning of cranial nerve-related disorders.
     
     In LGP, it is able to delineate the various cranial nerves using ‘Region and Volumes’ to avoid a radio-induced cranial nerve injury in GKS for tumor. Moreover we use LGP to simulate a pre-operative 3D-view from neurosurgeon very clearly indeed, especially in using 3D-CISS (FIESTA) with contrast medium sequences in MRI. A real-view of cranial nerves can be demonstrated in comparing a pre-operative 3D-simulation. After the decision of the placement and brain mapping electrode before tumor resection, we could prepare a precise map where electrodes are placed on or through cerebral cortices. In a recent version of LGP, we use the application ‘Co-registration’ to determine a placement of electrode for brain mapping in using between a pre-operative MRI and post-operative thin-slices of CT scan. The evaluation of preciseness the image fusion as well as post-operative MRI can be demonstrated after the estimation of brain function with these electrodes. Finally we investigate the easier installation of DTI fusion technique in LGP application ‘Co-registration and Pre-Plan’ for GKS as well as that in our information-guided tumor surgery.
     LGP application is very useful for nerve delineation and preparation of brain mapping in neurosurgery. Rapid and appropriate preparation for mapping is confirmed in the real-time mapping. Easy installation of DTI (FA and tracking) in LGP is also promising if the further evaluation of distortion and accuracy between series of MRI (DTI) acquisition would be examined.
     A quantitative comparison between techniques will need to be performed.
     We preliminarily demonstrate the fusion of routine MRI (MPR, T2, FLAIR) and DTI (FA image) in the recent LGP to detect neural network comparing with our guided tractography images. These findings can be applied in Leksell SurgiPlan.
     This simulation helps neurosurgeons to avoid a pitfall of the cranial nerve adhesion or passing beside the tumor.


Acknowledgements

Project Roles:

M. Tamura (), Y. Konishi (), N. Tamura (), N. Nakao (), U. Yuji (), T. Itakura (), J. Regis (), M. Hayashi (), Y. Muragaki (), H. Iseki ()