Diffusion tensor imaging–based fiber tracking for prediction of the position of the facial nerve in relation to large vestibular schwannomas

2011 ◽  
Vol 115 (6) ◽  
pp. 1087-1093 ◽  
Author(s):  
Venelin M. Gerganov ◽  
Mario Giordano ◽  
Madjid Samii ◽  
Amir Samii
Keyword(s):  
Diffusion Tensor Imaging ◽  
Facial Nerve ◽  
Diffusion Tensor ◽  
Fiber Tracking ◽  
Anatomical Location ◽  
Visualization Technique ◽  
Correlative Analysis ◽  
Nerve Tumor ◽  
Anatomical Images

Object The reliable preoperative visualization of facial nerve location in relation to vestibular schwannoma (VS) would allow surgeons to plan tumor removal accordingly and may increase the safety of surgery. In this prospective study, the authors attempted to validate the reliability of facial nerve diffusion tensor (DT) imaging–based fiber tracking in a series of patients with large VSs. Furthermore, the authors evaluated the potential of this visualization technique to predict the morphological shape of the facial nerve (tumor compression–related flattening of the nerve). Methods Diffusion tensor imaging and anatomical images (constructive interference in steady state) were acquired in a series of 22 consecutive patients with large VSs and postprocessed with navigational software to obtain facial nerve fiber tracking. The location of the cerebellopontine angle (CPA) part of the nerve in relation to the tumor was recorded during surgery by the surgeon, who was blinded to the results of the fiber tracking. A correlative analysis was performed of the imaging-based location of the nerve compared with its in situ position in relation to the VS. Results Fibers corresponding to the anatomical location and course of the facial nerve from the brainstem to the internal auditory meatus were identified with the DT imaging–based fiber tracking technique in all 22 cases. The location of the CPA segment of the facial nerve in relation to the VS determined during surgery corresponded to the location of the fibers, predicted by the DT imaging–based fiber tracking, in 20 (90.9%) of the 22 patients. No DT imaging–based fiber tracking correlates were found with the 2 morphological types of the nerve (compact or flat). Conclusions The current study of patients with large VSs has shown that the position of the facial nerve in relation to the tumor can be predicted reliably (in 91%) using DT imaging–based fiber tracking. These are preliminary results that need further verification in a larger series.

scholarly journals In vivo visualization of the facial nerve in patients with acoustic neuroma using diffusion tensor imaging–based fiber tracking

2016 ◽  
Vol 125 (4) ◽  
pp. 787-794 ◽  
Author(s):  
Fei Song ◽  
Yuanzheng Hou ◽  
Guochen Sun ◽  
Xiaolei Chen ◽  
Bainan Xu ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Diffusion Tensor ◽  
Fiber Tracking ◽  
Vestibular Nerve ◽  
Preoperative Imaging ◽  
Electrophysiological Monitoring ◽  
Exact Position

OBJECTIVE Preoperative determination of the facial nerve (FN) course is essential to preserving its function. Neither regular preoperative imaging examination nor intraoperative electrophysiological monitoring is able to determine the exact position of the FN. The diffusion tensor imaging–based fiber tracking (DTI-FT) technique has been widely used for the preoperative noninvasive visualization of the neural fasciculus in the white matter of brain. However, further studies are required to establish its role in the preoperative visualization of the FN in acoustic neuroma surgery. The object of this study is to evaluate the feasibility of using DTI-FT to visualize the FN. METHODS Data from 15 patients with acoustic neuromas were collected using 3-T MRI. The visualized FN course and its position relative to the tumors were determined using DTI-FT with 3D Slicer software. The preoperative visualization results of FN tracking were verified using microscopic observation and electrophysiological monitoring during microsurgery. RESULTS Preoperative visualization of the FN using DTI-FT was observed in 93.3% of the patients. However, in 92.9% of the patients, the FN visualization results were consistent with the actual surgery. CONCLUSIONS DTI-FT, in combination with intraoperative FN electrophysiological monitoring, demonstrated improved FN preservation in patients with acoustic neuroma. FN visualization mainly included the facial-vestibular nerve complex of the FN and vestibular nerve.

scholarly journals Dorsal displacement of the facial nerve in vestibular schwannoma surgery

2021 ◽  
Vol 5 (2) ◽  
pp. V9
Author(s):  
Gustavo S. Jung ◽  
Joel Fernando Sanabria Duarte ◽  
Afonso H. de Aragão ◽  
Ronaldo Pereira Vosgerau ◽  
Ricardo Ramina
Keyword(s):  
Diffusion Tensor Imaging ◽  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Diffusion Tensor ◽  
Fiber Tracking ◽  
Vestibular Schwannomas ◽  
Tumor Capsule ◽  
Link Type ◽  
Risk Of Injury ◽  
Diffusion Tensor Imaging Dti

The course of the facial nerve (FN) has been extensively investigated in patients with vestibular schwannomas (VSs). FN running dorsally to the tumor capsule accounts for less than 3% of the cases. Diffusion tensor imaging (DTI)–based fiber tracking helps to preoperatively identify the FN. During surgery, a higher risk of injury is associated with the dorsal location of the FN. The authors demonstrate the nuances and tricks to identify and preserve a dorsal displaced FN during resection of a large VS, T3b according to the Hannover classification, through the retrosigmoid-transmeatal approach. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID2182

scholarly journals Visualization of nerve fibers and their relationship to peripheral nerve tumors by diffusion tensor imaging

2015 ◽  
Vol 39 (3) ◽  
pp. E16 ◽  
Author(s):  
Tene A. Cage ◽  
Esther L. Yuh ◽  
Stephanie W. Hou ◽  
Harjus Birk ◽  
Neil G. Simon ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Peripheral Nerve ◽  
Nerve Fiber ◽  
Predictive Value ◽  
Diffusion Tensor ◽  
Retrospective Chart Review ◽  
Nerve Fibers ◽  
Anatomical Location ◽  
Nerve Tumor ◽  
Intraoperative Localization

OBJECT The majority of growing and/or symptomatic peripheral nerve tumors are schwannomas and neurofibromas. They are almost always benign and can usually be resected while minimizing motor and sensory deficits if approached with the proper expertise and techniques. Intraoperative electrophysiological stimulation and recording techniques allow the surgeon to map the surface of the tumor in an effort to identify and thus avoid damaging functioning nerve fibers. Recently, MR diffusion tensor imaging (DTI) techniques have permitted the visualization of axons, because of their anisotropic properties, in peripheral nerves. The object of this study was to compare the distribution of nerve fibers as revealed by direct electrical stimulation with that seen on preoperative MR DTI. METHODS The authors conducted a retrospective chart review of patients with a peripheral nerve or nerve root tumor between March 2012 and January 2014. Diffusion tensor imaging and intraoperative data had been prospectively collected for patients with peripheral nerve tumors that were resected. Preoperative identification of the nerve fiber location in relation to the nerve tumor surface as seen on DTI studies was compared with the nerve fiber’s intraoperative localization using electrophysiological stimulation and recordings. RESULTS In 23 patients eligible for study there was good correlation between nerve fiber location on DTI and its anatomical location seen intraoperatively. Diffusion tensor imaging demonstrated the relationship of nerve fibers relative to the tumor with 95.7% sensitivity, 66.7% specificity, 75% positive predictive value, and 93.8% negative predictive value. CONCLUSIONS Preoperative DTI techniques are useful in helping the peripheral nerve surgeon to both determine the risks involved in resecting a nerve tumor and plan the safest surgical approach.

scholarly journals Preoperative diffusion tensor imaging–fiber tracking for facial nerve identification in vestibular schwannoma: a systematic review on its evolution and current status with a pooled data analysis of surgical concordance rates

2018 ◽  
Vol 44 (3) ◽  
pp. E5 ◽  
Author(s):  
Amey R. Savardekar ◽  
Devi P. Patra ◽  
Jai D. Thakur ◽  
Vinayak Narayan ◽  
Nasser Mohammed ◽  
...  
Keyword(s):  
Systematic Review ◽  
Diffusion Tensor Imaging ◽  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Diffusion Tensor ◽  
Fiber Tracking ◽  
Pooled Analysis ◽  
Current Status ◽  
Cochrane Library ◽  
Female Ratio

OBJECTIVETotal tumor excision with the preservation of neurological function and quality of life is the goal of modern-day vestibular schwannoma (VS) surgery. Postoperative facial nerve (FN) paralysis is a devastating complication of VS surgery. Determining the course of the FN in relation to a VS preoperatively is invaluable to the neurosurgeon and is likely to enhance surgical safety with respect to FN function. Diffusion tensor imaging–fiber tracking (DTI-FT) technology is slowly gaining traction as a viable tool for preoperative FN visualization in patients with VS.METHODSA systematic review of the literature in the PubMed, Cochrane Library, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and those studies that preoperatively localized the FN in relation to a VS using the DTI-FT technique and verified those preoperative FN tracking results by using microscopic observation and electrophysiological monitoring during microsurgery were included. A pooled analysis of studies was performed to calculate the surgical concordance rate (accuracy) of DTI-FT technology for FN localization.RESULTSFourteen studies included 234 VS patients (male/female ratio 1:1.4, age range 17–75 years) who had undergone preoperative DTI-FT for FN identification. The mean tumor size among the studies ranged from 29 to 41.3 mm. Preoperative DTI-FT could not visualize the FN tract in 8 patients (3.4%) and its findings could not be verified in 3 patients (1.2%), were verified but discordant in 18 patients (7.6%), and were verified and concordant in 205 patients (87.1%).CONCLUSIONSPreoperative DTI-FT for FN identification is a useful adjunct in the surgical planning for large VSs (> 2.5 cm). A pooled analysis showed that DTI-FT successfully identifies the complete FN course in 96.6% of VSs (226 of 234 cases) and that FN identification by DTI-FT is accurate in 90.6% of cases (205 of 226 cases). Larger studies with DTI-FT–integrated neuronavigation are required to look at the direct benefit offered by this specific technique in preserving postoperative FN function.

Preoperative identification of the facial nerve in patients with large cerebellopontine angle tumors using high-density diffusion tensor imaging

2012 ◽  
Vol 116 (4) ◽  
pp. 697-702 ◽  
Author(s):  
Neil Roundy ◽  
Johnny B. Delashaw ◽  
Justin S. Cetas
Keyword(s):  
Diffusion Tensor Imaging ◽  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Diffusion Tensor ◽  
Tumor Resection ◽  
High Density ◽  
Imaging Method ◽  
Study Objective ◽  
Nerve Preservation ◽  
Imaging Results

Object Facial nerve paresis can be a devastating complication following resection of large (> 2.5 cm) cerebellopontine angle (CPA) tumors. The authors have developed and used a new high-density diffusion tensor imaging (HD-DT imaging) method, aimed at preoperatively identifying the location and course of the facial nerve in relation to large CPA tumors. Their study objective was to preoperatively identify the facial nerve in patients with large CPA tumors and compare their HD-DT imaging method with a traditional standard DT imaging method and correlate with intraoperative findings. Methods The authors prospectively studied 5 patients with large (> 2.5 cm) CPA tumors. All patients underwent preoperative traditional standard- and HD-DT imaging. Imaging results were correlated with intraoperative findings. Results Utilizing their HD-DT imaging method, the authors positively identified the location and course of the facial nerve in all patients. In contrast, using a standard DT imaging method, the authors were unable to identify the facial nerve in 4 of the 5 patients. Conclusions The HD-DT imaging method that the authors describe and use has proven to be a powerful, accurate, and rapid method for preoperatively identifying the facial nerve in relation to large CPA tumors. Routine integration of HD-DT imaging in preoperative planning for CPA tumor resection could lead to improved facial nerve preservation.

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