Diffusion tensor imaging for anatomical localization of cranial nerves and cranial nerve nuclei in pontine lesions: initial experiences with 3T-MRI. Ulrich, H, N., Ahmadli, U., Woernle, M, C., Alzarhani, A, Y., Bertalanffy, H., Kollias, & S, S. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 21(11):1924--7, November, 2014.
Diffusion tensor imaging for anatomical localization of cranial nerves and cranial nerve nuclei in pontine lesions: initial experiences with 3T-MRI. [link]Paper  doi  abstract   bibtex   
With continuous refinement of neurosurgical techniques and higher resolution in neuroimaging, the management of pontine lesions is constantly improving. Among pontine structures with vital functions that are at risk of being damaged by surgical manipulation, cranial nerves (CN) and cranial nerve nuclei (CNN) such as CN V, VI, and VII are critical. Pre-operative localization of the intrapontine course of CN and CNN should be beneficial for surgical outcomes. Our objective was to accurately localize CN and CNN in patients with intra-axial lesions in the pons using diffusion tensor imaging (DTI) and estimate its input in surgical planning for avoiding unintended loss of their function during surgery. DTI of the pons obtained pre-operatively on a 3Tesla MR scanner was analyzed prospectively for the accurate localization of CN and CNN V, VI and VII in seven patients with intra-axial lesions in the pons. Anatomical sections in the pons were used to estimate abnormalities on color-coded fractional anisotropy maps. Imaging abnormalities were correlated with CN symptoms before and after surgery. The course of CN and the area of CNN were identified using DTI pre- and post-operatively. Clinical associations between post-operative improvements and the corresponding CN area of the pons were demonstrated. Our results suggest that pre- and post-operative DTI allows identification of key anatomical structures in the pons and enables estimation of their involvement by pathology. It may predict clinical outcome and help us to better understand the involvement of the intrinsic anatomy by pathological processes.
@article{ ulrich_diffusion_2014,
  title = {Diffusion tensor imaging for anatomical localization of cranial nerves and cranial nerve nuclei in pontine lesions: initial experiences with 3T-{MRI}.},
  volume = {21},
  url = {http://www.ncbi.nlm.nih.gov/pubmed/24998855},
  doi = {10.1016/j.jocn.2014.03.027},
  abstract = {With continuous refinement of neurosurgical techniques and higher resolution in neuroimaging, the management of pontine lesions is constantly improving. Among pontine structures with vital functions that are at risk of being damaged by surgical manipulation, cranial nerves (CN) and cranial nerve nuclei (CNN) such as CN V, VI, and VII are critical. Pre-operative localization of the intrapontine course of CN and CNN should be beneficial for surgical outcomes. Our objective was to accurately localize CN and CNN in patients with intra-axial lesions in the pons using diffusion tensor imaging (DTI) and estimate its input in surgical planning for avoiding unintended loss of their function during surgery. DTI of the pons obtained pre-operatively on a 3Tesla MR scanner was analyzed prospectively for the accurate localization of CN and CNN V, VI and VII in seven patients with intra-axial lesions in the pons. Anatomical sections in the pons were used to estimate abnormalities on color-coded fractional anisotropy maps. Imaging abnormalities were correlated with CN symptoms before and after surgery. The course of CN and the area of CNN were identified using DTI pre- and post-operatively. Clinical associations between post-operative improvements and the corresponding CN area of the pons were demonstrated. Our results suggest that pre- and post-operative DTI allows identification of key anatomical structures in the pons and enables estimation of their involvement by pathology. It may predict clinical outcome and help us to better understand the involvement of the intrinsic anatomy by pathological processes.},
  number = {11},
  journal = {Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia},
  author = {Ulrich, Nils H and Ahmadli, Uzeyir and Woernle, Christoph M and Alzarhani, Yahea A and Bertalanffy, Helmut and Kollias, Spyros S},
  month = {November},
  year = {2014},
  keywords = {Adult, Anatomic Landmarks, Brain Stem Neoplasms, Brain Stem Neoplasms: complications, Brain Stem Neoplasms: surgery, Cavernous, Central Nervous System, Central Nervous System: com, Central Nervous System: sur, Cranial Nerve Diseases, Cranial Nerve Diseases: etiology, Cranial Nerve Injuries, Cranial Nerve Injuries: prevention \& control, Cranial Nerves, Cranial Nerves: anatomy \& histology, Diffusion Tensor Imaging, Diffusion Tensor Imaging: methods, Female, Hemangioma, Humans, Intraoperative Complications, Intraoperative Complications: prevention \& control, Male, Microsurgery, Microsurgery: methods, Middle Aged, Neuroimaging, Neuroimaging: methods, Neuronavigation, Neuronavigation: methods, Pons, Pons: surgery, Prospective Studies, Retrospective Studies, Young Adult},
  pages = {1924--7}
}
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