Neuroimaging of White Matter Recovery: A New Outcome Measure in Tumor Surgery
Author(s): ,
S. Koga
Ochsner Neuroscience Institute, University of Queensland, Department of Neurosurgery, New Orleans, United States
S. Fillip
Ochsner Neuroscience Institute, University of Queensland, New Orleans, United States
EANS Academy. Koga S. 10/21/18; 225986; EP3026
Assoc. Prof. Sebastian Koga
Assoc. Prof. Sebastian Koga
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Advances in diffusion tensor imaging and neuronavigation have brought white matter tractography to the forefront of brain tumor surgery. The technology is used for planning transsulcal parafascicular approaches to subcortical lesions. Our study is the first to define and quantify the distortion of white matter tracts pre-operatively and the recovery of white matter tracts post-operatively. This provides a proxy outcome measure based on neuroimaging, and opens new avenues for studying the progression of subcortical lesions.

A prospective study of 50 patients undergoing resection of subcortical lesions was undertaken using transsulcal parafascicular approaches. Three dimensional fiber tract maps were created from DTI MRI images and were analyzed in a dynamic fashion using automated computational models and dynamic manipulation of the fiber tracts. The concept of 'tract recovery” was developed by quantifying deviation, deformation, infiltration, interruption and degeneration before and after surgery. Complex computational models were reduce to create a simple 'coefficient of coherence (ξ)' measuring tract variation from the normal hemisphere, and from normal anatomy based on brain atlas models.

Our quantification model using high-fidelity tractography allows surgeons to demonstrate white matter recovery and to plan optimal corridors for tract preservation. Recovery of white matter tracts was noted in all cases, even in congenital lesions, yielding unexpected insights into neural plasticity. The workload of 3D computational analysis was reduced to a clinically useful 'coefficient of coherence (ξ)' which indicates return to normal anatomy. Tractography outcomes were accurately correlated to clinical outcomes.

The advent of tridimensional DTI maps and automated tractography can enhanced not only surgical planning, but also the measurement of surgical outcomes using existing neuroimaging tools. Meaningful simplification of algorithms can give surgeons useful and user-friendly tools such as the coefficient of coherence (ξ).
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