Study: MRI technique can help plan removal of benign brain tumors in children

Diffusion tensor imaging (DTI) and white matter tractography successfully identifies white matter fibers stemming from the precentral gyrus prior to surgery within the posterior limb of the internal capsule in children with thalamic juvenile pilocytic astrocytomas (JPAs), or benign tumors in the thalamus of the brain, said a study published in the December issue of Journal of Neurosurgery: Pediatrics.

The study found success in utilizing the MRI technique, DTI, in the stereotactic planning of approach to resection of thalamic JPAs, which are commonly deep-seated tumors that present a challenge for neurosurgeons, said the authors.

The six children--all aged 18 or under--involved in the study underwent preoperative DTI, performed on a 1.5T MRI system (Avanto, Siemens Healthcare) in gathering conventional MR images for diagnostic purposes. The images were then sent to a post-processing workstation (Siemens' Leonardo), where diffusion tensors were calculated.

The authors said that DTI can help identify white matter, or nerve fiber bundles, using specific radio-frequency and magnetic field pulses to track the movement of water molecules of the brain.

The study's lead author Yaron A. Moshel, MD, of the department of neurosurgery at Bellevue Hospital Medical Center in New York City, and colleagues performed the six stereotactic tumor resections between February 2006 and November 2008. The goal of each operation was the resection of the entire contrast-enhancing solid and cystic tumor mass identified on preoperative MR images.

Post-surgery, neurological exams were performed by the same pediatric neurologist or neuro-oncologist that had performed the exam preoperatively. Post-operative exams took place on the first postoperative day, one week after surgery, three months and six months post-surgery.

The authors graded all immediate postoperative neurological shortfalls as mild (minimal deficit that is noticeable) or moderate (deficit that interferes with function, but could be overcome) within all of their six participants. However, the authors said that four of the six patients were back to their preoperative baseline at the six-month follow-up point.

“Diffusion tensor imaging served as a valuable tool for stereotactic planning of operative approaches to thalamic JPAs. Localizing the position of the posterior limb of the internal capsule helped minimize potential neurological morbidity and facilitated gross-total resection,” concluded the authors.

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