Abstract
Background and study object: The Dominant Atrium (DA) is a crossroad of eloquent white matter bundles difficult to preserve with a standard “anatomical” approach. The aim of this work is to evaluate the results of a cohort of patients who underwent surgery with the aid of a purely functional MRI and DTI-based approach. Materials and methods: 43 patients suffering from lesions involving the DA have been included in the final cohort and studied in regards to quality of life (KPS); a special attention was lent on the incidence of new or worsening of preexisting neurological deficits, with a focus on motor, visual and speech disturbances after the surgical treatment. Patient, surgery and lesion-related data were recorded to identify the relationships with outcome. Eloquent areas fMRI and the course of Arcuate Fasciculus (AF), Inferior frontooccipital fasciculus (IFOF), Optic radiation (OR) and corticospinal tract (CST) have been investigated with preoperative MRI sequences and DTI reconstruction. Results: The final cohort consisted of 43 patients, 19 males and 24 females; average age was 56.8 years. We recorded 9 transient and 3 permanent postoperative deficits, only one of those was caused by an edema interference with DTI reconstruction. Preoperative functional status, histology and volume of the lesion proved to be independent factors affecting results. Conclusions: A purely functional surgical approach to the DA provided promising preliminary results. A direct DTI-fMRI visualization of the eloquent structures proximal to DA allows surgeon to conceive an ultra-precise and “tailored” cortico-leucotomy for an optimal exposure of the lesion.
| Original language | English |
|---|---|
| Pages (from-to) | 252-261 |
| Number of pages | 10 |
| Journal | Journal of Clinical Neuroscience |
| Volume | 50 |
| DOIs | |
| Publication status | Published - Apr 1 2018 |
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Keywords
- DTI
- fMRI
- Intraventricular tumors
- Left atrium
ASJC Scopus subject areas
- Surgery
- Neurology
- Clinical Neurology
- Physiology (medical)
Cite this
A purely functional Imaging based approach for transcortical resection of lesion involving the dominant atrium : Towards safer, imaging-guided, tailored cortico-leucotomies. / Frati, Alessandro; Pesce, Alessandro; D'Andrea, Giancarlo; Fraschetti, Flavia; Salvati, Maurizio; Cimatti, Marco; Esposito, Vincenzo; Raco, Antonino.
In: Journal of Clinical Neuroscience, Vol. 50, 01.04.2018, p. 252-261.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A purely functional Imaging based approach for transcortical resection of lesion involving the dominant atrium
T2 - Towards safer, imaging-guided, tailored cortico-leucotomies
AU - Frati, Alessandro
AU - Pesce, Alessandro
AU - D'Andrea, Giancarlo
AU - Fraschetti, Flavia
AU - Salvati, Maurizio
AU - Cimatti, Marco
AU - Esposito, Vincenzo
AU - Raco, Antonino
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Background and study object: The Dominant Atrium (DA) is a crossroad of eloquent white matter bundles difficult to preserve with a standard “anatomical” approach. The aim of this work is to evaluate the results of a cohort of patients who underwent surgery with the aid of a purely functional MRI and DTI-based approach. Materials and methods: 43 patients suffering from lesions involving the DA have been included in the final cohort and studied in regards to quality of life (KPS); a special attention was lent on the incidence of new or worsening of preexisting neurological deficits, with a focus on motor, visual and speech disturbances after the surgical treatment. Patient, surgery and lesion-related data were recorded to identify the relationships with outcome. Eloquent areas fMRI and the course of Arcuate Fasciculus (AF), Inferior frontooccipital fasciculus (IFOF), Optic radiation (OR) and corticospinal tract (CST) have been investigated with preoperative MRI sequences and DTI reconstruction. Results: The final cohort consisted of 43 patients, 19 males and 24 females; average age was 56.8 years. We recorded 9 transient and 3 permanent postoperative deficits, only one of those was caused by an edema interference with DTI reconstruction. Preoperative functional status, histology and volume of the lesion proved to be independent factors affecting results. Conclusions: A purely functional surgical approach to the DA provided promising preliminary results. A direct DTI-fMRI visualization of the eloquent structures proximal to DA allows surgeon to conceive an ultra-precise and “tailored” cortico-leucotomy for an optimal exposure of the lesion.
AB - Background and study object: The Dominant Atrium (DA) is a crossroad of eloquent white matter bundles difficult to preserve with a standard “anatomical” approach. The aim of this work is to evaluate the results of a cohort of patients who underwent surgery with the aid of a purely functional MRI and DTI-based approach. Materials and methods: 43 patients suffering from lesions involving the DA have been included in the final cohort and studied in regards to quality of life (KPS); a special attention was lent on the incidence of new or worsening of preexisting neurological deficits, with a focus on motor, visual and speech disturbances after the surgical treatment. Patient, surgery and lesion-related data were recorded to identify the relationships with outcome. Eloquent areas fMRI and the course of Arcuate Fasciculus (AF), Inferior frontooccipital fasciculus (IFOF), Optic radiation (OR) and corticospinal tract (CST) have been investigated with preoperative MRI sequences and DTI reconstruction. Results: The final cohort consisted of 43 patients, 19 males and 24 females; average age was 56.8 years. We recorded 9 transient and 3 permanent postoperative deficits, only one of those was caused by an edema interference with DTI reconstruction. Preoperative functional status, histology and volume of the lesion proved to be independent factors affecting results. Conclusions: A purely functional surgical approach to the DA provided promising preliminary results. A direct DTI-fMRI visualization of the eloquent structures proximal to DA allows surgeon to conceive an ultra-precise and “tailored” cortico-leucotomy for an optimal exposure of the lesion.
KW - DTI
KW - fMRI
KW - Intraventricular tumors
KW - Left atrium
UR - http://www.scopus.com/inward/record.url?scp=85041499535&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85041499535&partnerID=8YFLogxK
U2 - 10.1016/j.jocn.2018.01.045
DO - 10.1016/j.jocn.2018.01.045
M3 - Article
C2 - 29429789
AN - SCOPUS:85041499535
VL - 50
SP - 252
EP - 261
JO - Journal of Clinical Neuroscience
JF - Journal of Clinical Neuroscience
SN - 0967-5868
ER -