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首页> 外文期刊>Neurosurgical focus >Diffusion tensor tractography for the surgical management of peripheral nerve sheath tumors
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Diffusion tensor tractography for the surgical management of peripheral nerve sheath tumors

机译：扩散张量牵引，用于外周神经鞘瘤的手术管理

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OBJECT Peripheral nerve sheath tumors (PNSTs) are uncommon but bear a significant risk of malignancy. High-resolution MRI is the standard technique for characterizing PNSTs. However, planning the appropriate extent of resection and subsequent reconstructive strategies is highly dependent on the intraoperative findings because preoperative MRI evaluation can be insufficient. Diffusion tensor tractography (DTT) represents a recently developed advanced MRI technique that reveals the microstructure of tissues based on monitoring the random movement of water molecules. DTT has the potential to provide diagnostic insights beyond conventional MRI techniques due to its mapping of specific fibrillar nerve structures. Here, DTT was applied to evaluate PNSTs and to examine the usefulness of this method for the correct delineation of tumor and healthy nerve tissue and the value of this information in the preoperative planning of surgical interventions. METHODS In this prospective study, patients with the clinical symptoms of a PNST were investigated using DTT 3-Tesla MRI scans. Image data processing and tractography were performed using the FACT (fiber assessment by continuous tracking) algorithm and multiple-regions-of-interest approach. The surgical findings were then compared with the results of the DTT MRI scans. Preoperative fascicle visualization and the correlation with the intraoperative findings were graded. RESULTS In a 21-month period, 12 patients with PNSTs were investigated (7 female and 5 male patients with a mean age of 46.2 ± 19.2 years). All patients underwent surgical removal of the tumor. Schwannoma was the most common benign histopathological finding (n = 7), whereas 2 malignant lesions were detected. In 10 of 12 patients, good preoperative nerve fascicle visualization was achieved using DTT scans. In 9 of 10 patients with good preoperative fascicle visualization, good intraoperative correlation between the DTT scans and surgical anatomy was found. CONCLUSIONS DTT properly visualizes the peripheral nerve fascicles and their correct anatomical relation to PNST. DTT represents a promising new method for the preinterventional planning of nerve tumor resection.
机译：物体周围神经鞘瘤（PNSTS）罕见，但具有显着的恶性风险。高分辨率MRI是PNSTS表征的标准技术。然而，规划适当的切除程度和随后的重建策略高度依赖于术中发现，因为术前MRI评估可能不足。扩散张量牵引（DTT）表示最近开发的先进MRI技术，揭示了基于监测水分子随机运动的组织的微观结构。由于其对特定的纤维状神经结构的映射，DTT具有超出传统MRI技术的诊断洞察。这里，DTT被应用于评估PNST，并检查该方法的用途，用于正确描绘肿瘤和健康神经组织的逐划定和在手术干预的术前规划中的这种信息的价值。方法在这项前瞻性研究中，使用DTT 3-Tesla MRI扫描研究了PNST临床症状的患者。图像数据处理和牵引工是使用事实（通过连续跟踪的光纤评估）算法和兴趣多区域的方法进行。然后将手术结果与DTT MRI扫描的结果进行比较。术前雄性学性能和与术中发现的相关性分级。结果在21个月期间，调查了12名患有PNST的患者（7名女性和5名男性和5名46.2±19.2岁的男性患者）。所有患者均接受手术去除肿瘤。施瓦马瘤是最常见的良性组织病理学发现（n = 7），而检测到2个恶性病变。在12名患者中的10个中，使用DTT扫描实现了良好的术前神经束性可视化。在10名具有良好术前的初始毛刺可视化的患者中，发现DTT扫描与手术解剖学之间的良好术中相关性。结论DTT适当地可视化外周神经魅力及其与PNST的正确解剖关系。 DTT代表了神经肿瘤切除术前预防措施的有希望的新方法。

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