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J Neurosurg. 2019 Apr 19:1-11. doi: 10.3171/2019.1.JNS182638. [Epub ahead of print]

Full tractography for detecting the position of cranial nerves in preoperative planning for skull base surgery: technical note.

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1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
2Skull Base Multi-Disciplinary Unit, Department of Neurosurgery B, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon.
3CREATIS Laboratory CNRS UMR5220, Inserm U1206, INSA-Lyon, University of Lyon 1.
4Department of Neurosurgery, Stanford University Medical Center, Stanford, California.
5Department of Neuroradiology and MRI, Grenoble University Hospital, Grenoble, France; and.
6Department of Radiology, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon.


OBJECTIVEDiffusion imaging tractography has allowed the in vivo description of brain white matter. One of its applications is preoperative planning for brain tumor resection. Due to a limited spatial and angular resolution, it is difficult for fiber tracking to delineate fiber crossing areas and small-scale structures, in particular brainstem tracts and cranial nerves. New methods are being developed but these involve extensive multistep tractography pipelines including the patient-specific design of multiple regions of interest (ROIs). The authors propose a new practical full tractography method that could be implemented in routine presurgical planning for skull base surgery.METHODSA Philips MRI machine provided diffusion-weighted and anatomical sequences for 2 healthy volunteers and 2 skull base tumor patients. Tractography of the full brainstem, the cerebellum, and cranial nerves was performed using the software DSI Studio, generalized-q-sampling reconstruction, orientation distribution function (ODF) of fibers, and a quantitative anisotropy-based generalized deterministic algorithm. No ROI or extensive manual filtering of spurious fibers was used. Tractography rendering was displayed in a tridimensional space with directional color code. This approach was also tested on diffusion data from the Human Connectome Project (HCP) database.RESULTSThe brainstem, the cerebellum, and the cisternal segments of most cranial nerves were depicted in all participants. In cases of skull base tumors, the tridimensional rendering permitted the visualization of the whole anatomical environment and cranial nerve displacement, thus helping the surgical strategy.CONCLUSIONSAs opposed to classical ROI-based methods, this novel full tractography approach could enable routine enhanced surgical planning or brain imaging for skull base tumors.


CISS = constructive interference steady state; CN = cranial nerve; FSL = FMRIB software library; HCP = Human Connectome Project; HDFT = high-definition fiber tracking; ODF = orientation distribution function; ROA = region of avoidance; ROI = region of interest; cranial nerves; planning; skull base; surgical technique; tractography; tumor


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