Magnetic resonance diffusion tensor imaging with fluorescein sodium dyeing for surgery of gliomas in brain motor functional areas
- Author:
- No author available
- Journal Title:
- Chinese Medical Journal
- Issue:
- 13
- DOI:
- 10.3760/cma.j.issn.0366-6999.20122939
- Key Word:
- glioma;magnetic resonance diffusion tensor imaging;fluorescein sodium dyeing;brain motor functional area
Abstract： Background Tumor surgery in brain motor functional areas remains challenging.Novel techniques are being developed to gain maximal and safe resection for brain tumor surgery.Herein,we assessed the magnetic resonance diffusion tensor imaging (MR-DTI) and fluorescein sodium dyeing (FLS) guiding technique for surgery of glioma located in brain motor functional areas.Methods Totally 83 patients were enrolled according to our inclusion and exclusion criteria (56 patients in experimental group,27 patients in control group).In the experimental group,the surgical approach was designed by DTI imaging,which showed the relationship between the tumor and motor tract.The range of resection in the operation was determined using the FLS-stained area,which recognized the tumor and its infiltrated tissue.The traditional routine method was used in the control group.Postoperatively,all patients underwent enhanced brain MRI within 72 hours to ascertain the extent of resection.Patients were followed in our outpatient clinic over 6-24 months.Neurological deficits and Karnofsky scoring (KPS) were evaluated.Results There were no significant differences in balance test indexes of preoperative data (sex,age,lesion location and volume,and neurological deficits before operation) and diagnosis of histopathology between the two groups.There was a trend in the experimental group for greater rates of gross total resection (80.4％ vs.40.7％),and the paralysis rate caused by surgery was lower in experimental (25.0％) vs.control (66.7％) groups (P ＜0.05).The 6-month KPS in the low-grade and high-grade gliomas was 91±11 and 73±26,respectively,in the experimental group vs.82±9 and 43±27,respectively,in the control group (P ＜0.05 for both).Conclusions MR-DTI and FLS dye guiding for surgery of glioma located in brain motor functional areas can increase the gross total resection rate,decrease the paralysis rate caused by surgery,and improve patient quality of life compared with traditional glioma surgery.
- [1]胡新华,张岩松,刘翔,等.荧光导航辅助下切除功能区恶性胶质瘤[J].2006,(8).
- [2]Kim J,Mori S,Pearlson GD,etc.DtiStudio: resource program for diffusion tensor computation and fiber bundle tracking.[J].2006,81(2).
- [3]Song IC,Kim JH,Na DG,etc.Diffusion-tensor imaging for glioma grading at 3-T magnetic resonance imaging: analysis of fractional anisotropy and mean diffusivity.[J].2008,32(2).
- [4]C J, Price,E A, Warburton,C J, Moore,etc.Dynamic diaschisis: anatomically remote and context-sensitive human brain lesions.[J].2001,13(4).
- [5]Caterina Michelozzi,Antonella Castellano,Andrea Falini,etc.Role of diffusion tensor magnetic resonance tractography in predicting the extent of resection in glioma surgery[J].2012,14(2).
- [6]Duffau H,Mandonnet E,Taillandier L.Intraoperative subcortical stimulation mapping of language pathways in a consecutive series of 115 patients with Grade II glioma in the left dominant hemisphere.[J].2008,109(3).
- [7]Nimsky C,Ernst-Stecken A,Stadlbauer A,etc.Diffusion tensor imaging and optimized fiber tracking in glioma patients: Histopathologic evaluation of tumor-invaded white matter structures.[J].2007,34(3).
- [8]Burger PC,Olivi A,Brem H,etc.Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas.[J].2008,63(4).
- [9]Pianka P,Assaf Y,Hendler T,etc.Characterization of displaced white matter by brain tumors using combined DTI and fMRI.[J].2006,30(4).
- [10]Yaron A, Moshel,Robert E, Elliott,David J, Monoky,etc.Role of diffusion tensor imaging in resection of thalamic juvenile pilocytic astrocytoma.[J].2009,4(6).
- [11]Reusche E,Krajewski J,Petkus N,etc.Multiphoton excitation of autofluorescence for microscopy of glioma tissue.[J].2006,58(4).
- [12]W, Stummer,S, Stocker,S, Wagner,etc.Intraoperative detection of malignant gliomas by 5-aminolevulinic acid-induced porphyrin fluorescence.[J].1998,42.
- [13]Bauer, M.H.,Kuhnt, D.,Nimsky, C..Brain shift compensation and neurosurgical image fusion using intraoperative MRI: current status and future challenges.[J].2012,40(3).
- [14]Salomonowitz E,Kuwert T,Nimsky C,etc.Metabolic Imaging of Cerebral Gliomas: Spatial Correlation of Changes in O-(2-18F-Fluoroethyl)-L-Tyrosine PET and Proton Magnetic Resonance Spectroscopic Imaging.[J].2008,49(5).
- [15]Fahlbusch R,Wang R,Hastreiter P,etc.Intraoperative diffusion-tensor MR imaging: shifting of white matter tracts during neurosurgical procedures--initial experience.[J].2005,234(1).
- [16]Todo T,Aoki S,Kawahara N,etc.Combined use of tractography-integrated functional neuronavigation and direct fiber stimulation.[J].2005,102(4).
- [17]Ji XM,Qin W,Li KC,etc.Diffusion tensor tractography in patients with cerebral tumors: a helpful technique for neurosurgical planning and postoperative assessment.[J].2005,56(2).
- [18]McGirt MJ,Chaichana KL,Gathinji M,etc.Independent association of extent of resection with survival in patients with malignant brain astrocytoma.[J].2009,110(1).
- [19]Nimsky C,Prante O,Stadlbauer A,etc.Detection of tumour invasion into the pyramidal tract in glioma patients with sensorimotor deficits by correlation of (18)F-fluoroethyl-L: -tyrosine PET and magnetic resonance diffusion tensor imaging.[J].2009,151(9).
- [20]Nimsky C,Stadlbauer A,Hammen T,etc.Gliomas: histopathologic evaluation of changes in directionality and magnitude of water diffusion at diffusion-tensor MR imaging.[J].2006,240(3).
- [21]Kaku Y,Sakai N,Shinoda J,etc.Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium. Technical note.[J].2003,99(3).
- [22]Kuroiwa T,Kajimoto Y,Ohta T.Development of a fluorescein operative microscope for use during malignant glioma surgery: a technical note and preliminary report.[J].1998,50(1).
- [23]Jiang Y,Hsu EW.Accelerating MR diffusion tensor imaging via filtered reduced-encoding projection-reconstruction.[J].2005,53(1).
- [24]Henry RG,Berger MS,Nagarajan SS,etc.Accuracy of diffusion tensor magnetic resonance imaging tractography assessed using intraoperative subcortical stimulation mapping and magnetic source imaging.[J].2007,107(3).
- [25]Stummer W,Wiestler OD,Meinel T,etc.Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial.[J].2006,7(5).