A purely functional Imaging based approach for transcortical resection of lesion involving the dominant atrium: Towards safer, imaging-guided, tailored cortico-leucotomies

Alessandro Frati, Alessandro Pesce, Giancarlo D'Andrea, Flavia Fraschetti, Maurizio Salvati, Marco Cimatti, Vincenzo Esposito, Antonino Raco

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 languageEnglish
Pages (from-to)252-261
Number of pages10
JournalJournal of Clinical Neuroscience
Volume50
DOIs
Publication statusPublished - Apr 1 2018

Fingerprint

Magnetic Resonance Imaging
Psychosurgery
Pyramidal Tracts
Edema
Histology
Quality of Life
Radiation
Incidence
Therapeutics
Optic Tract
Surgeons
White Matter

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 journalArticle

@article{758a45c06d55495aa4818b5cd4421cb1,
title = "A purely functional Imaging based approach for transcortical resection of lesion involving the dominant atrium: Towards safer, imaging-guided, tailored cortico-leucotomies",
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.",
keywords = "DTI, fMRI, Intraventricular tumors, Left atrium",
author = "Alessandro Frati and Alessandro Pesce and Giancarlo D'Andrea and Flavia Fraschetti and Maurizio Salvati and Marco Cimatti and Vincenzo Esposito and Antonino Raco",
year = "2018",
month = "4",
day = "1",
doi = "10.1016/j.jocn.2018.01.045",
language = "English",
volume = "50",
pages = "252--261",
journal = "Journal of Clinical Neuroscience",
issn = "0967-5868",
publisher = "Churchill Livingstone",

}

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 -