The role of 3D tractography in skull base surgery: Technological advances, feasibility, and early clinical assessment with anterior skull base meningiomas

Authors

Srikant S Chakravarthi, Advocate Aurora HealthFollow
Melanie B. Fukui, Advocate Aurora HealthFollow
Alejandro Monroy-Sosa, Advocate Aurora HealthFollow
Lior Gonen
Austin Epping, Advocate Aurora Health
Jonathan E. Jennings, Advocate Aurora HealthFollow
Laila Perez de San Roman Mena, Advocate Aurora Health
Sammy Khalili, Advocate Aurora HealthFollow
Maharaj Singh, Advocate Aurora HealthFollow
Juanita M. Celix, Advocate Aurora HealthFollow
Bhavani Kura, Advocate Aurora Health
Nthaniel Kojis, Advocate Aurora HealthFollow
Richard A. Rovin, Advocate Aurora HealthFollow
Amin B Kassam, Advocate Aurora Health

Recommended Citation

Chakravarthi SS, Fukui MB, Monroy-Sosa A, et al. The role of 3d tractography in skull base surgery: technological advances, feasibility, and early clinical assessment with anterior skull base meningiomas. J Neurol Surg B Skull Base. 2021;82(5):576-592. doi: 10.1055/s-0040-1713775

Affiliations

Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Aurora St. Luke's Medical Center

Abstract

Objective: The aim of this study is to determine feasibility of incorporating three-dimensional (3D) tractography into routine skull base surgery planning and analyze our early clinical experience in a subset of anterior cranial base meningiomas (ACM).

Methods: Ninety-nine skull base endonasal and transcranial procedures were planned in 94 patients and retrospectively reviewed with a further analysis of the ACM subset.

Main Outcome Measures: (1) Automated generation of 3D tractography; (2) co-registration 3D tractography with computed tomography (CT), CT angiography (CTA), and magnetic resonance imaging (MRI); and (3) demonstration of real-time manipulation of 3D tractography intraoperatively. ACM subset: (1) pre- and postoperative cranial nerve function, (2) qualitative assessment of white matter tract preservation, and (3) frontal lobe fluid-attenuated inversion recovery (FLAIR) signal abnormality.

Results: Automated 3D tractography, with MRI, CT, and CTA overlay, was produced in all cases and was available intraoperatively. ACM subset : 8 (44%) procedures were performed via a ventral endoscopic endonasal approach (EEA) corridor and 12 (56%) via a dorsal anteromedial (DAM) transcranial corridor. Four cases (olfactory groove meningiomas) were managed with a combined, staged approach using ventral EEA and dorsal transcranial corridors. Average tumor volume reduction was 90.3 ± 15.0. Average FLAIR signal change was -30.9% ± 58.6. 11/12 (92%) patients (DAM subgroup) demonstrated preservation of, or improvement in, inferior fronto-occipital fasciculus volume. Functional cranial nerve recovery was 89% (all cases).

Conclusion: It is feasible to incorporate 3D tractography into the skull base surgical armamentarium. The utility of this tool in improving outcomes will require further study.

Document Type

Article

PubMed ID

34513565