Trigonal and Peritrigonal Lesions of The Lateral Ventricle

Pre-Surgical Tractographic Planning and Clinic Outcome Evaluation

Romano Andrea, D'Andrea Giancarlo, Pesce Alessandro, Olivieri Giorgia, Rossi-Espagnet Maria Camilla, Picotti Veronica, Raco Antonino, Bozzao Alessandro

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Surgery of lesions within the atrium of the lateral ventricle remains a challenging procedure because of the deep location and the relationship to vascular structures. The aim of this study was to determine the usefulness of tractography to evaluate the position of white matter tracts located along the course of the surgical access to trigonal and para-trigonal lesions.

METHODS: Diffusion Tensor Imaging (DTI) was acquired in 19 patients. All patients underwent surgical resection of brain tumors. Pre- and postoperative clinical conditions were evaluated by a neurosurgeon, using Karnofsky scale. Thecorticospinal tract, optic radiation and arcuate fasciculum were reconstructed because of their location close to the trigonal region. Two neurosurgeons were asked to assess the surgical approach with and without tractography.

RESULTS: According to the tractographic reconstructions, the surgical access was chosen from the middle temporal gyrus in 12 patients (63%) or in the posterior parietal gyrus in 7 patients (37%), leading to an a priori change in the surgical approach in 14 patients (73%). Six patients (31%) showed new post-surgical transient symptoms, while in two (10%) deficits were permanent. After 30 days, the Karnofsky scale evaluation showed an improvement or a substantial stability of symptoms in 90% of cases. In 2 patients a worsening of 30% of clinical performance was appreciable.

CONCLUSION: The use of DTI in preoperative planning of trigonal and para-trigonal region may help in the definition of the best surgical approach being able assess the anatomic pathways of white matter tracts with respect to the tumor, especially in location.

Original languageEnglish
Number of pages7
JournalWorld Neurosurgery
DOIs
Publication statusE-pub ahead of print - Dec 29 2018

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Lateral Ventricles
Karnofsky Performance Status
Diffusion Tensor Imaging
Temporal Lobe
Brain Neoplasms
Blood Vessels
Radiation
Neoplasms

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Trigonal and Peritrigonal Lesions of The Lateral Ventricle : Pre-Surgical Tractographic Planning and Clinic Outcome Evaluation. / Andrea, Romano; Giancarlo, D'Andrea; Alessandro, Pesce; Giorgia, Olivieri; Maria Camilla, Rossi-Espagnet; Veronica, Picotti; Antonino, Raco; Alessandro, Bozzao.

In: World Neurosurgery, 29.12.2018.

Research output: Contribution to journalArticle

Andrea, Romano ; Giancarlo, D'Andrea ; Alessandro, Pesce ; Giorgia, Olivieri ; Maria Camilla, Rossi-Espagnet ; Veronica, Picotti ; Antonino, Raco ; Alessandro, Bozzao. / Trigonal and Peritrigonal Lesions of The Lateral Ventricle : Pre-Surgical Tractographic Planning and Clinic Outcome Evaluation. In: World Neurosurgery. 2018.
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title = "Trigonal and Peritrigonal Lesions of The Lateral Ventricle: Pre-Surgical Tractographic Planning and Clinic Outcome Evaluation",
abstract = "BACKGROUND: Surgery of lesions within the atrium of the lateral ventricle remains a challenging procedure because of the deep location and the relationship to vascular structures. The aim of this study was to determine the usefulness of tractography to evaluate the position of white matter tracts located along the course of the surgical access to trigonal and para-trigonal lesions.METHODS: Diffusion Tensor Imaging (DTI) was acquired in 19 patients. All patients underwent surgical resection of brain tumors. Pre- and postoperative clinical conditions were evaluated by a neurosurgeon, using Karnofsky scale. Thecorticospinal tract, optic radiation and arcuate fasciculum were reconstructed because of their location close to the trigonal region. Two neurosurgeons were asked to assess the surgical approach with and without tractography.RESULTS: According to the tractographic reconstructions, the surgical access was chosen from the middle temporal gyrus in 12 patients (63{\%}) or in the posterior parietal gyrus in 7 patients (37{\%}), leading to an a priori change in the surgical approach in 14 patients (73{\%}). Six patients (31{\%}) showed new post-surgical transient symptoms, while in two (10{\%}) deficits were permanent. After 30 days, the Karnofsky scale evaluation showed an improvement or a substantial stability of symptoms in 90{\%} of cases. In 2 patients a worsening of 30{\%} of clinical performance was appreciable.CONCLUSION: The use of DTI in preoperative planning of trigonal and para-trigonal region may help in the definition of the best surgical approach being able assess the anatomic pathways of white matter tracts with respect to the tumor, especially in location.",
author = "Romano Andrea and D'Andrea Giancarlo and Pesce Alessandro and Olivieri Giorgia and {Maria Camilla}, Rossi-Espagnet and Picotti Veronica and Raco Antonino and Bozzao Alessandro",
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T2 - Pre-Surgical Tractographic Planning and Clinic Outcome Evaluation

AU - Andrea, Romano

AU - Giancarlo, D'Andrea

AU - Alessandro, Pesce

AU - Giorgia, Olivieri

AU - Maria Camilla, Rossi-Espagnet

AU - Veronica, Picotti

AU - Antonino, Raco

AU - Alessandro, Bozzao

N1 - Copyright © 2018. Published by Elsevier Inc.

PY - 2018/12/29

Y1 - 2018/12/29

N2 - BACKGROUND: Surgery of lesions within the atrium of the lateral ventricle remains a challenging procedure because of the deep location and the relationship to vascular structures. The aim of this study was to determine the usefulness of tractography to evaluate the position of white matter tracts located along the course of the surgical access to trigonal and para-trigonal lesions.METHODS: Diffusion Tensor Imaging (DTI) was acquired in 19 patients. All patients underwent surgical resection of brain tumors. Pre- and postoperative clinical conditions were evaluated by a neurosurgeon, using Karnofsky scale. Thecorticospinal tract, optic radiation and arcuate fasciculum were reconstructed because of their location close to the trigonal region. Two neurosurgeons were asked to assess the surgical approach with and without tractography.RESULTS: According to the tractographic reconstructions, the surgical access was chosen from the middle temporal gyrus in 12 patients (63%) or in the posterior parietal gyrus in 7 patients (37%), leading to an a priori change in the surgical approach in 14 patients (73%). Six patients (31%) showed new post-surgical transient symptoms, while in two (10%) deficits were permanent. After 30 days, the Karnofsky scale evaluation showed an improvement or a substantial stability of symptoms in 90% of cases. In 2 patients a worsening of 30% of clinical performance was appreciable.CONCLUSION: The use of DTI in preoperative planning of trigonal and para-trigonal region may help in the definition of the best surgical approach being able assess the anatomic pathways of white matter tracts with respect to the tumor, especially in location.

AB - BACKGROUND: Surgery of lesions within the atrium of the lateral ventricle remains a challenging procedure because of the deep location and the relationship to vascular structures. The aim of this study was to determine the usefulness of tractography to evaluate the position of white matter tracts located along the course of the surgical access to trigonal and para-trigonal lesions.METHODS: Diffusion Tensor Imaging (DTI) was acquired in 19 patients. All patients underwent surgical resection of brain tumors. Pre- and postoperative clinical conditions were evaluated by a neurosurgeon, using Karnofsky scale. Thecorticospinal tract, optic radiation and arcuate fasciculum were reconstructed because of their location close to the trigonal region. Two neurosurgeons were asked to assess the surgical approach with and without tractography.RESULTS: According to the tractographic reconstructions, the surgical access was chosen from the middle temporal gyrus in 12 patients (63%) or in the posterior parietal gyrus in 7 patients (37%), leading to an a priori change in the surgical approach in 14 patients (73%). Six patients (31%) showed new post-surgical transient symptoms, while in two (10%) deficits were permanent. After 30 days, the Karnofsky scale evaluation showed an improvement or a substantial stability of symptoms in 90% of cases. In 2 patients a worsening of 30% of clinical performance was appreciable.CONCLUSION: The use of DTI in preoperative planning of trigonal and para-trigonal region may help in the definition of the best surgical approach being able assess the anatomic pathways of white matter tracts with respect to the tumor, especially in location.

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JO - World Neurosurgery

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