Trigonal and Peritrigonal Lesions of The Lateral Ventricle: Pre-Surgical Tractographic Planning and Clinic Outcome Evaluation.

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Trigonal and Peritrigonal Lesions of The Lateral Ventricle: Pre-Surgical Tractographic Planning and Clinic Outcome Evaluation.

World Neurosurg. 2018 Dec 29;:

Authors: Andrea R, Giancarlo D, Alessandro P, Giorgia O, Maria Camilla RE, Veronica P, Antonino R, Alessandro B

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 para-trigonal 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 Karnofsky scale. Thecorticospinal 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%) or in 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 post-surgical transient symptoms, while in two (10%) deficits were permanent. After 30 days, the Karnofsky 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.
CONCLUSION: The use of DTI in preoperative planning of trigonal and para-trigonal region may help in the definition of the best surgical approach being able assess the anatomic pathways of white matter tracts with respect to the tumor, especially in location.

PMID: 30599250 [PubMed - as supplied by publisher]

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