Papillary Ependymoma WHO Grade II of the Aqueduct Treated by Endoscopic Tumor Resection

Papillary ependymoma is a rare tumor that may be located along the ventricular walls or within the spinal cord. We report the case of a 54-year-old patient with a papillary ependymoma WHO grade II arising at the entrance of the aqueduct. The tumor caused hydrocephalus. The tumor was completely removed via a right-sided endoscopic approach with restoration of the aqueduct. The free cerebrospinal fluid passage through the aqueduct was not only visualized by endoscopy but also controlled by intraoperative high-field magnetic resonance imaging. Therefore, an additional endoscopic third ventriculostomy was unneccessary

The DTI Challenge: Toward Standardized Evaluation of Diffusion Tensor Imaging Tractography for Neurosurgery: The DTI Challenge on Tractography for Neurosurgery

Diffusion tensor imaging tractography reconstruction of white matter pathways can help guide brain tumor resection. However, DTI tracts are complex mathematical objects and the validity of tractography-derived information in clinical settings has yet to be fully established. To address this issue, we initiated the DTI Challenge, an international working group of clinicians and scientists whose goal was to provide standardized evaluation of tractography methods for neurosurgery. The purpose of this empirical study was to evaluate different tractography techniques in the first DTI Challenge workshop

Integration of Interventional MRI With ComputerAssisted Surgery

integration of image data into the surgical procedure (2). How to present volume data sets optimally remains an open question and the topic of basic research in visualization. It is our overall goal to integrate all the available information (both multimodal preoperative and intraoperative imaging data) into a single comprehensive display. In the beginning, computerized methods (so-called navigational tools) were developed for image-guided neurosurgery. Currently, advanced computer-assisted surgical capabilities that were developed for the brain have been extended to other clinical applications (endoscopic sinus surgery, spinal surgery, and orthopedics). In the field of interventional magnetic resonance imaging (IMRI), besides neurosurgery and other MRI-guided open surgeries (spine, breast, etc.), MRI-guided prostate brachytherapy and other MRI-guided thermal ablations are the key testbeds (3--7). Several other applications, such as MRIguided endoscopic procedures, are under develop

Non-invasive qualitative and semiquantitative presurgical investigation of the feeding vasculature to intracranial meningiomas using superselective arterial spin labeling.

BackgroundIntracranial meningiomas may be amenable to presurgical embolization to reduce bleeding complications. Detailed information usually obtained by digital subtraction angiography (DSA) on the contribution of blood supply from internal and external carotid artery branches is required to prevent non-target embolization and is helpful for pre-surgical planning.PurposeTo investigate the contribution of the feeding vasculature to intracranial meningiomas with superselective arterial spin labelling (sASL) as an alternative to DSA.Material and methodsConsecutive patients presenting for meningioma resection were prospectively included. sASL perfusion images acquired on a clinical 3T MRI scanner were independently rated by two readers. Contribution of the external carotid artery (ECA), internal carotid artery (ICA) and vertebral/basilar artery (VA/BA) was rated as none, 50%. Correlation of sASL was performed in two patients undergoing DSA.Results32 patients (61 ± 13 years) harboring 42 meningiomas could be included. sASL was technically successful in all patients. 19 meningiomas had ICA dominant supply, 19 had ECA dominant supply. One meningioma had mixed supply and in three meningiomas a perfusion signal could not be detected. While exclusive unilateral ECA supply was common (n = 14) and exclusive unilateral ICA was rare (n = 4), mixed supply from multiple vessels (n = 20) was a frequent finding. Interrater agreement was substantial (κ = 0.73). Agreement with DSA was perfect within our predefined categories.ConclusionsASL is able to identify the presence and extent of the feeding vasculature in intracranial meningiomas

An Integrated Visualization System for Surgical Planning and Guidance using Image Fusion and Interventional Imaging

. We present a software package which uniquely integrates several facets of image-guided medicine into a single portable, extendable environment. It provides capabilities for automatic registration, semiautomatic segmentation, 3D surface model generation, 3D visualization, and quantitative analysis of various medical scans. We describe its system architecture, wide range of applications, and novel integration with an interventional Magnetic Resonance (MR) scanner to augment intraoperative imaging with pre-operative data. Analysis previously reserved for pre-operative data can now be applied to exploring the anatomical changes as the surgery progresses. Surgical instruments are tracked and used to drive the location of reformatted slices. Real-time scans are visualized as slices in the same 3D view along with the pre-operative slices and surface models. The system has been applied in over 20 neurosurgical cases at Brigham and Women's Hospital, and continues to be routinely ..