Trigonal and Peritrigonal Lesions of the Lateral Ventricle: Presurgical 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

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 peritrigonal 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 the Karnofsky Performance Status Scale. The corticospinal 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%) and 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 postsurgical transient symptoms, whereas in 2 patients (10%) the deficits were permanent. After 30 days, the Karnofsky Performance Status 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. Conclusions: The use of DTI in preoperative planning of trigonal and peritrigonal lesions may help in description of the best surgical approach for patient; this technique allows to reach the tumors, saving the white matter tracts, when it is possible.

Original languageEnglish
JournalWorld Neurosurgery
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

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

Keywords

  • MRI
  • Presurgical planning
  • Tractography
  • Trigonal lesions

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Trigonal and Peritrigonal Lesions of the Lateral Ventricle : Presurgical 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.

In: World Neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

Romano, Andrea ; D'Andrea, Giancarlo ; Pesce, Alessandro ; Olivieri, Giorgia ; Rossi-Espagnet, Maria Camilla ; Picotti, Veronica ; Raco, Antonino ; Bozzao, Alessandro. / Trigonal and Peritrigonal Lesions of the Lateral Ventricle : Presurgical Tractographic Planning and Clinic Outcome Evaluation. In: World Neurosurgery. 2019.
@article{29b8f040a9ce4bb88957826dc00cc8d5,
title = "Trigonal and Peritrigonal Lesions of the Lateral Ventricle: Presurgical 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 peritrigonal 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 the Karnofsky Performance Status Scale. The corticospinal 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{\%}) and 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 postsurgical transient symptoms, whereas in 2 patients (10{\%}) the deficits were permanent. After 30 days, the Karnofsky Performance Status 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. Conclusions: The use of DTI in preoperative planning of trigonal and peritrigonal lesions may help in description of the best surgical approach for patient; this technique allows to reach the tumors, saving the white matter tracts, when it is possible.",
keywords = "MRI, Presurgical planning, Tractography, Trigonal lesions",
author = "Andrea Romano and Giancarlo D'Andrea and Alessandro Pesce and Giorgia Olivieri and Rossi-Espagnet, {Maria Camilla} and Veronica Picotti and Antonino Raco and Alessandro Bozzao",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.wneu.2018.12.086",
language = "English",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Trigonal and Peritrigonal Lesions of the Lateral Ventricle

T2 - Presurgical Tractographic Planning and Clinic Outcome Evaluation

AU - Romano, Andrea

AU - D'Andrea, Giancarlo

AU - Pesce, Alessandro

AU - Olivieri, Giorgia

AU - Rossi-Espagnet, Maria Camilla

AU - Picotti, Veronica

AU - Raco, Antonino

AU - Bozzao, Alessandro

PY - 2019/1/1

Y1 - 2019/1/1

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 peritrigonal 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 the Karnofsky Performance Status Scale. The corticospinal 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%) and 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 postsurgical transient symptoms, whereas in 2 patients (10%) the deficits were permanent. After 30 days, the Karnofsky Performance Status 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. Conclusions: The use of DTI in preoperative planning of trigonal and peritrigonal lesions may help in description of the best surgical approach for patient; this technique allows to reach the tumors, saving the white matter tracts, when it is possible.

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 peritrigonal 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 the Karnofsky Performance Status Scale. The corticospinal 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%) and 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 postsurgical transient symptoms, whereas in 2 patients (10%) the deficits were permanent. After 30 days, the Karnofsky Performance Status 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. Conclusions: The use of DTI in preoperative planning of trigonal and peritrigonal lesions may help in description of the best surgical approach for patient; this technique allows to reach the tumors, saving the white matter tracts, when it is possible.

KW - MRI

KW - Presurgical planning

KW - Tractography

KW - Trigonal lesions

UR - http://www.scopus.com/inward/record.url?scp=85060527500&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060527500&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2018.12.086

DO - 10.1016/j.wneu.2018.12.086

M3 - Article

AN - SCOPUS:85060527500

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -