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Tractography-Enhanced Biopsy of Central Core Motor Eloquent Tumours: A Simulation-Based Study

Authors :
Harishchandra Lalgudi Srinivasan
Jose Pedro Lavrador
Kantharuby Tambirajoo
Graeme Pang
Sabina Patel
Richard Gullan
Francesco Vergani
Ranjeev Bhangoo
Jonathan Shapey
Ahilan Kailaya Vasan
Keyoumars Ashkan
Source :
Journal of Personalized Medicine; Volume 13; Issue 3; Pages: 467
Publication Year :
2023
Publisher :
Multidisciplinary Digital Publishing Institute, 2023.

Abstract

Safe Trajectory planning for navigation guided biopsy (nBx) of motor eloquent tumours (METs) is important to minimise neurological morbidity. Preliminary clinical data suggest that visualisation of the corticospinal tract (CST) and its relation to the tumour may aid in planning a safe trajectory. In this article we assess the impact of tractography in nBx planning in a simulation-based exercise. This single centre cross-sectional study was performed in March 2021 including 10 patients with METs divided into 2 groups: (1) tractography enhanced group (T-nBx; n = 5; CST merged with volumetric MRI); (2) anatomy-based group (A-nBx; n = 5; volumetric MRI only). A biopsy target was chosen on each tumour. Volunteer neurosurgical trainees had to plan a suitable biopsy trajectory on a Stealth S8® workstation for all patients in a single session. A trajectory safety index (TSI) was devised for each trajectory. Data collection and analysis included a comparison of trajectory planning time, trajectory/lobe changes and TSI. A total of 190 trajectories were analysed based on participation from 19 trainees. Mean trajectory planning time for the entire cohort was 225.1 ± 21.97 s. T-nBx required shorter time for planning (p = 0.01). Mean trajectory changes and lobe changes made per biopsy were 3.28 ± 0.29 and 0.45 ± 0.08, respectively. T-nBx required fewer trajectory/lobe changes (p = 0.01). TSI was better in the presence of tractography than A-nBx (p = 0.04). Neurosurgical experience of trainees had no significant impact on the measured parameters despite adjusted analysis. Irrespective of the level of neurosurgical training, surgical planning of navigation guided biopsy for METs may be achieved in less time with a safer trajectory if tractography imaging is available.

Details

Language :
English
ISSN :
20754426
Database :
OpenAIRE
Journal :
Journal of Personalized Medicine; Volume 13; Issue 3; Pages: 467
Accession number :
edsair.doi.dedup.....6d4b3125a29419c08fcc9dcbfcdb0aed
Full Text :
https://doi.org/10.3390/jpm13030467