Brainstem Cavernoma Surgery with the Support of Pre- and Postoperative Diffusion Tensor Imaging

Nils Harry-Bert Ulrich1, Ralf Kockro, PhD1, David Bellut1, Oliver Bozinov, MD1, Jan Burkhardt1, Spyros Kollias1, Helmut Bertalanffy1

1Zurich, Switzerland

Keywords: brain stem, outcome, cavernous malformation, diffusion tensor imaging, magnetic resonance imaging

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     Diffusion tensor imaging (DTI) allows visualization of white matter tracts and enables better understanding of the anatomical location of corticospinal and sensory tracts before and after surgery. We investigated the feasibility of DTI based fiber-tractography in patients with brainstem cavernomas (BSC).
     We assessed the accuracy of fiber visualization and the correlation to clinical outcome.
     22 individual with BSC.
     Pre- and postoperative DTI visualization of corticospinal and sensory tracts were retrospectively analyzed in 22 individuals with BSC. Preoperative and postoperative DTI-fiber accuracy were correlated to the neurological findings.
     Preoperatively, DTI was available in 20 out of 22 patients. The corticospinal tracts were visualized in 90 % of the cases. The sensory tracts could be visualized in 85 % of the patients. Postoperatively, DTI was available in 14 out of 22 cases. The corticospinal tract was visualized in 97 % of the cases. Sensory tracts could be visualized in 79 % of the patients. BSC had caused displacement, thinning or interruption of the fiber tracts to various degrees. Tract visualization correlated with pre- and postoperative neurological findings, suggesting anatomically accurate fiber depiction. Postoperative damage of the corticospinal tracts was not detected in any case. In one patient the sensory tracts could not be visualized postoperatively.
     This is a retrospective study.
     DTI-tractography allows detailed white matter tract visualization even in cases of a lesion in the brainstem. W
     e found a clear correlation between the appearances of the tracts and the neurological status of the patients. Visualizing the tracts surrounding the lesion improves our understanding of the distorted intrinsic anatomy when analyzing and planning these cases.


Project Roles:

N. Ulrich (), R. Kockro (), D. Bellut (), O. Bozinov (), J. Burkhardt (), S. Kollias (), H. Bertalanffy ()