• World Neurosurg · Dec 2018

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

    • Andrea Romano, Giancarlo D'Andrea, Alessandro Pesce, Giorgia Olivieri, Maria Camilla Rossi-Espagnet, Veronica Picotti, Antonino Raco, and Alessandro Bozzao.
    • Department of Odontostomatological and Maxillo-Facial Sciences, Umberto I Hospital, University Sapienza, Rome, Italy; NESMOS, Department of Neuroradiology, S.Andrea Hospital, University Sapienza, Rome, Italy. Electronic address: andrea.romano@uniroma1.it.
    • World Neurosurg. 2018 Dec 30.

    BackgroundSurgery 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 peritrigonal lesions.MethodsDiffusion 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 the Karnofsky Performance Status Scale. The corticospinal 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.ResultsAccording to the tractographic reconstructions, the surgical access was chosen from the middle temporal gyrus in 12 patients (63%) and 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 postsurgical transient symptoms, whereas in 2 patients (10%) the deficits were permanent. After 30 days, the Karnofsky Performance Status 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.ConclusionsThe use of DTI in preoperative planning of trigonal and peritrigonal lesions may help in description of the best surgical approach for patient; this technique allows to reach the tumors, saving the white matter tracts, when it is possible.Copyright © 2018. Published by Elsevier Inc.

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