Stanford Fiber Tractography Lab - Surgical Planning
Neurosurgeons deal with a wide range of pathology including tumors, vascular malformations, endocrine disorders and epilepsy, amongst others. Prior to the introduction of magnetic resonance imaging (MRI), there was no accurate way to visualize neural tissue in the brain at an adequate level of detail. MRI, introduced during the 1980’s revolutionized both grey and white matter visualization. Tractography adds an extra layer to this visualization ability. It permits white matter architecture to be studied and is particularly useful to show how tumors and other space-occupying lesions distort surrounding tissues.
When conducted pre-operatively, tractography permits the surgeon to visualize a lesion and the structures surrounding it. Every region of the human brain serves a function and utmost care must be taken by the neurosurgeon to prevent unnecessary damage to healthy tissues adjacent to the pathology. Damage to surrounding structures may produce undesirable post-operative outcomes. Tractography permits the surgeon to visualize the critical functional tissues surrounding the lesion and modify their angles of approach in order to minimize damage and ensure function is maintained post-operatively.
After the surgery, tractography can be conducted again to demonstrate once-distorted tissues returning to normal following removal of the lesion. Sometimes the surgeon is left with no choice but to remove critical white matter structures due to invasion by highly-aggressive tumors. In these cases, tractography may give an idea of the functional consequences that the patient may encounter following surgery. Subsequent action and plans can then be put into place to address these issues and maximize a patients’ quality of life prior to leaving the hospital.
Selected References
1.) Fernandez-Miranda, J. C., Pathak, S., Engh, J., Jarbo, K., Verstynen, T., Yeh, F. C., ... & Friedlander, R. (2012). High-definition fiber tractography of the human brain: neuroanatomical validation and neurosurgical applications. Neurosurgery, 71(2), 430-453.
2.) Abhinav, K., Yeh, F. C., Mansouri, A., Zadeh, G., & Fernandez-Miranda, J. C. (2015). High-definition fiber tractography for the evaluation of perilesional white matter tracts in high-grade glioma surgery. Neuro-oncology, 17(9), 1199-1209.
3.) Fernandez-Miranda, J. C., Engh, J. A., Pathak, S. K., Madhok, R., Boada, F. E., Schneider, W., & Kassam, A. B. (2010). High-definition fiber tracking guidance for intraparenchymal endoscopic port surgery. Journal of neurosurgery, 113(5), 990-999.
4.) Meola, A., Yeh, F. C., Fellows-Mayle, W., Weed, J., & Fernandez-Miranda, J. C. (2016). Human connectome-based tractographic atlas of the brainstem connections and surgical approaches. Neurosurgery, 79(3), 437-455.