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Pre-surgical planning and MR-tractography utility in brain tumour resection
European Radiology, 06/22/09

Romano A et al. – Data suggest that MR-tractography provides the neurosurgeon with a new anatomical view that has an impact on the surgical resection planning for brain neoplasms.

Methods

Main objectives of this study were:
1. To evaluate the possible identification of trajectories of fibre tracts
2. To examine the useful of a neuronavigation system for pre-surgical planning
3. To assess pre- and post-surgery pts’ clinical condition and
4. To evaluate the impact of this information on surgical planning and procedure
28 right-handed pts were prospectively and consecutively studied
All pts were clinically assessed by a neurologist in both pre- and post-surgical phases
Separately the pyramidal tract, optic radiation and arcuate fasciculus were reconstructed
Trajectories were considered suitable for surgical planning if there were no interruptions of any of the layers at the level of the lesion

Results

Assessment of 37 visualised trajectories close to the tumour resulted in a modification of the surgical approach to corticotomy in 21% pts
Impact on the definition of the resection margins during surgery was 64%
Overall impact percentage on the surgical procedure was 82%
In 27 cases, the symptoms had not changed

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