Surgical Treatment Of Intracranial Lesions By Neuronavigation Integrated With Functinal Magetic Resonance Imaging And Tractography

Objective: To explore the clinical value of functional neuronavigation-assisted operations on brain occupying lesions involving motor cortex through individualized keyhole approaches.Methods: Ten patients with brain occupying lesions involving the motor cortex were studied prospectively. Preoperatively these patients underwent T1-3D and functional MR scanning, then MRI data were input to one Stryker neuronavigator to design suitable keyhole approaches. Intraoperatively, careful resection of lesions was performed according to the real-time identified spatial relationship between the motor activation regions and the brain occupying lesions by the navigator.Results: One mass was subtotally removed, one partially removed and eight totally removed (80%). Four patients appeared transient myodynamia deterioration after surgery, while the others'neurological status was the same as their preoperative status. All patients didn't present any neurological deterioration after three months postoperatively. Furthermore, 2 patients demonstrated improved myodynamia. Postoperative Karnofsky Performance Scales were significantly higher than preoperative ones.Conclusion: The treatment of functional neuronavigation-assisted surgery on brain occupying lesions involving motor cortex through keyhole approaches is a minimally invasive way to maximize tumor resection and effectively protect neurological functions simultaneously. It is beneficial to increase the safety of surgery, decrease operative complications and improve the postoperative quality of life.Objective: To valuate the application of tractography-based neuronavigation in operations on brain lesions involving the pyramidal tract or the optic radiation.Methods: Tractography-based neuronavigation was tested prospectively in the resection of fifteen intracranial lesions, among which 8 involved the pyramidal tract, 6 involved the optic radiation and 1 involved both. Preoperatively, normal MRI and special diffusion tensor imaging (DTI) were performed. Then the related images were input and fused in one neuronavigator. Then the spatial relationship of the tracts and the lesions was demonstrated intuitively. Accordingly, suitable approaches were designed. Afterwards, real-time navigation guided removal of lesions was performed.Results: In the study group, total lesion resection was achieved in 12 patients, subtotal in 1, and partial in 2 patients After 3 months of follow-up, all patients didn't present any neurological deterioration, while enhanced muscle strength was observed in 3 cases with their pyramidal tracts involved preoperatively. And visual fields were found improved in 2 cases with the optic radiation involved preoperatively. The therapeutic effect of the patients with pyramidal tracts involved in the study group was significantly better than that in the control group.Conclusion: The tractography-based neuronavigation in surgery of brain lesions involving the pyramidal tract or the optic radiation is a minimally invasive tool to maximize lesion resection and effectively protect key tracts simultaneously. It is helpful to reduce operative complications, decrease disability rates and improve the postoperative quality of life.