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Intra-operative Real-time Querying of White Matter Tracts during Frameless Stereotactic Neuronavigation

1Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
2BrainLAB AG, Feldkirchen, Germany.
3Golby Laboratory, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
4Department of Diagnostic Radiology, Yale University of Medicine, and Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
Publication Date:
Volume Number:
Issue Number:
Neurosurgery. 2011 Feb;68(2):506-16; discussion 516.
PubMed ID:
Diffusion Tensor Imaging, Intraoperative Tractography, Neuronavigation, Real-time Tractography, White Matter
Appears in Collections:
P41 RR019703/RR/NCRR NIH HHS/United States
P01 CA067165/CA/NCI NIH HHS/United States
R01 EB006494/EB/NIBIB NIH HHS/United States
Generated Citation:
Elhawary H., Liu H., Patel P., Norton I., Rigolo L., Papademetris X., Hata N., Golby A.J. Intra-operative Real-time Querying of White Matter Tracts during Frameless Stereotactic Neuronavigation. Neurosurgery. 2011 Feb;68(2):506-16; discussion 516. PMID: 21135719. PMCID: PMC3121103.
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Brain surgery faces important challenges when trying to achieve maximum tumor resection while avoiding post-operative neurological deficits. OBJECTIVE: In order for surgeons to have optimal intraoperative information concerning white matter anatomy, we developed a platform that allows the intra-operative real-time querying of tractography datasets during frameless stereotactic neuronavigation. METHODS: Structural magnetic resonance imaging (MRI), functional MRI, and diffusion tensor imaging (DTI) were performed on 5 patients before undergoing lesion resection using neuronavigation. During the procedure, the tracked surgical tool tip position was transferred from the navigation system to the 3D Slicer software package, which used this position to seed the white matter tracts around the tool tip location, rendering a geometric visualization of these tracts on the pre-operative images previously loaded onto the navigation system. The clinical feasibility of this approach was evaluated during five cases of lesion resection. In addition, system performance was evaluated by measuring the latency between surgical tool tracking and visualization of the seeded white matter tracts. RESULTS: Lesion resection was performed successfully in all five patients. The seeded white matter tracts close to the lesion and other critical structures, as defined by the functional and structural images, were interactively visualized during the intervention to determine their spatial relationships relative to the lesion and critical cortical areas. Latency between tracking and visualization of tracts was less than a second for fiducial radius size of 4-5mm. CONCLUSION:: Interactive tractography can provide an intuitive way of inspecting critical white matter tracts in the vicinity of the surgical region, allowing the surgeon to have increased intra-operative white matter information to execute the planned surgical resection.

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