Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Matteo Zoli; Lia Talozzi; Micaela Mitolo; Raffaele Lodi; Diego Mazzatenta; Caterina Tonon

doi:10.3791/61724

Rolle der Diffusions-MRT-Traktographie in der endoskopischen endonasalen Schädelbasischirurgie

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Neuroscience

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JoVE Journal Neuroscience

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Rolle der Diffusions-MRT-Traktographie in der endoskopischen endonasalen Schädelbasischirurgie

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09:53 min

July 5, 2021

DOI: 10.3791/61724-v

Matteo Zoli*^1,2, Lia Talozzi*², Micaela Mitolo³, Raffaele Lodi^2,4, Diego Mazzatenta*^1,2, Caterina Tonon*^2,3

¹IRCCS Istituto delle Scienze Neurologiche di Bologna,Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases - Pituitary Unit, ²Department of Biomedical and NeuroMotor Sciences,University of Bologna, ³IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, ⁴IRCCS Istituto delle Scienze Neurologiche di Bologna

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Overview

This study presents a protocol for integrating diffusion MRI tractography in patient evaluations for endoscopic endonasal surgery aimed at skull base tumors. It outlines methods to utilize neuroimaging studies effectively during both pre- and intra-operative phases to enhance surgical safety and patient outcomes.

Key Study Components

Area of Science

Neurosurgery
Neuroimaging
Oncology

Background

Diffusion MRI tractography allows visualization of white matter tracts and tumor proximity.
This technique has shown versatility in glioma surgery and applications in drug-resistant focal epilepsy.
Integration improves surgical safety and quality of life for patients with pituitary and skull base tumors.
Collaboration between imaging and surgical specialists is vital for optimal outcomes.

Purpose of Study

To establish a framework for the safe resection of tumors using advanced neuroimaging techniques.
To correlate neuroimaging data with clinical outcomes in surgical contexts.
To provide training tips for integrating these techniques in surgical practice.

Methods Used

Utilized multi-modal MRI on high-field scanners to acquire various sequences for tumor localization and tractography.
Employed a detailed stepwise approach for segmentation and analysis using ITK-SNAP and FSL tools.
Detailed protocols outline MRI parameters, image acquisition specifics, and assessment techniques.
Included a comprehensive surgical protocol for endoscopic procedures based on imaging findings.

Main Results

Advanced imaging allowed for better visualization of critical structures, enhancing surgical navigation.
Successful demonstration of the method has the potential to standardize practices across surgical teams.
Encouragement of collaborative discussions among specialists contributes to improved surgical planning.

Conclusions

The integration of diffusion MRI tractography enhances the precision of endoscopic surgeries.
This study illustrates the importance of specialized training in both imaging and surgical techniques.
Findings promote a better understanding of tumor interactions with eloquent brain structures, paving the way for future advancements in surgical oncology.

Frequently Asked Questions

What are the main advantages of using diffusion MRI tractography?

Diffusion MRI tractography provides clear visualizations of white matter structures, improving surgical navigation and decreasing the risk of injury to critical neural pathways during tumor resection.

How is the biological model implemented in this study?

The biological model focuses on patients with skull base tumors, using imaging to tailor surgical approaches based on individual anatomical features and tumor location.

What types of data are obtained through these imaging methods?

Imaging methods yield detailed anatomical maps identifying tumor relationships with brain structures, contributing to safe surgical planning and execution.

How can the methods be adapted for different types of surgeries?

Methods outlined can be customized to fit various surgical approaches by modifying imaging parameters based on the specific tumor type and location.

Are there any key limitations associated with this approach?

While promising, the reliance on advanced imaging techniques necessitates significant training and familiarity with the technology, which may not be uniformly available across all surgical centers.

Wir präsentieren ein Protokoll zur Integration der Diffusions-MRT-Traktographie in die Patientenaufarbeitung zur endoskopischen endonasalen Chirurgie für einen Schädelbasistumor. Die Methoden zur Übernahme dieser Neuroimaging-Studien in der prä- und intraoperativen Phase werden beschrieben.

Mit Hilfe eines integrierten Neuroimaging- und Neurochirurgie-Protokolls ist es möglich, verschiedene Expertisen in einem synergentischen Rahmen zusammenzuführen, um eine patientenspezifische Tumorresektionsoperation maßgeschneidert zu gestalten. Mit Hilfe der MRT-Traktographie ist es möglich, die Dislokation des Trakts der weißen Substanz und die Tumorentfernung zu visualisieren. Seine Vielseitigkeit in der Gliomchirurgie ist erwiesen und kann auch bei medikamentenresistenter fokaler Epilepsie angewendet werden.

Die Integration fortschrittlicher Neuroimaging-Techniken in die endoskopische endonasale Chirurgie bei Hypophysen-, Zwischenhirn- und Schädeltumoren erhöht wirksam die chirurgische Sicherheit, reduziert die Komplikationen und verbessert die Patientenergebnisse und die Lebensqualität. Die MRT-Traktographie in Kombination mit der Aufgaben-fMRT ermöglicht die Überwachung der strukturellen und funktionellen Reorganisation des Gehirns nach der Operation. Darüber hinaus ist die Korrelation mit klinischen Ergebnissen für klinische und Forschungsvorschläge nützlich.

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