Identification of the pyramidal tract by neuronavigation based on intraoperative diffusion-weighted imaging combined with subcortical stimulation

N. Ozawa, Y. Muragaki, R. Nakamura, H. Iseki

    Research output: Contribution to journalArticle

    22 Citations (Scopus)

    Abstract

    Background/Aims: To identify the pyramidal tract by neuronavigation based on intraoperative diffusion-weighted imaging (iDWI) combined with subcortical stimulation. Methods: Seven patients with brain tumors near the deep white matter underwent resection surgery using neuronavigation based on iDWI to visualize white matter bundles. Subcortical electrical stimulation was performed and electromyography was measured at the extremities when surgical manipulation came near the position corresponding to the depicted bundle. We validated the bundle depicted on iDWI by considering the responses to subcortical stimulation and the distance between the stimulation site and the depicted bundle. Results: Positive motor-evoked potentials were detected in 5 of 7 patients (8 stimulations) and the distance from the stimulation site to the depicted bundle was 0-4.7 mm (mean ± SD, 1.4 ± 2.1 mm). Negative (no) responses were obtained in all patients when the distance was more than 5 mm. The neuronavigation system had an average error of 0.79 ± 0.25 mm and a maximum error of 2.0 mm (n = 16). Conclusion: Neuronavigation based on iDWI combined with subcortical stimulation allowed surgeons to identify the pyramidal tract and avoid inadvertent injury. Our findings demonstrate that the white matter bundles depicted by iDWI can contain the pyramidal tract.

    Original languageEnglish
    Pages (from-to)18-24
    Number of pages7
    JournalStereotactic and Functional Neurosurgery
    Volume87
    Issue number1
    DOIs
    Publication statusPublished - 2009 Feb 1

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    Keywords

    • Brain shift
    • Diffusion-weighted imaging
    • Fiber tracking
    • Functional mapping
    • Intraoperative magnetic resonance imaging
    • Neuronavigation
    • Pyramidal tract
    • Subcortical stimulation

    ASJC Scopus subject areas

    • Surgery
    • Clinical Neurology

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