Tractography for Optic Radiation Preservation in Transcortical Approaches to Intracerebral Lesions

• Type of Material: Report
• Authors: Vijay Agarwal, Emory University; James G. Malcolm, Emory University; Gustavo Pradilla, Emory University; Daniel L Barrow, Emory University
• Language: English
• Date: 2017-09-28
• Publisher: Cureus
• Copyright Statement: © Copyright 2017 Agarwal et al.
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.1722
• Title of Journal or Parent Work: Open Access Case Report
• Keywords: synaptive; brainpath; intraventricular mass; neurosurgery; diffusion tensor imaging; meningioma

Abstract

We present a case of intraventricular meningioma resected via a transcortical approach using tractography for optic radiation and arcuate fasciculus preservation. We include a review of the literature. A 54-year-old woman with a history of breast cancer presented with gait imbalance. Workup revealed a mass in the atrium of the left lateral ventricle consistent with a meningioma. Whole brain automated diffusion tensor imaging (DTI) was used to plan a transcortical resection while sparing the optic radiations and arcuate fasciculus. A left posterior parietal craniotomy was performed using the Synaptive BrightMatter™ frameless navigation (Synaptive Medical, Toronto, Canada) to minimally disrupt the white matter pathways. A gross total resection was achieved. Postoperatively, the patient had temporary right upper extremity weakness, which improved, and her visual fields and speech remained intact. Pathology confirmed a World Health Organization (WHO) Grade I meningothelial meningioma. While a thorough understanding of cortical anatomy is essential for safe resection of eloquent or deep-seated lesions, significant variability in fiber bundles, such as optic radiations and the arcuate fasciculus, necessitates a more individualized understanding of a patient’s potential surgical risk. The addition of enhanced DTI to the neurosurgeon’s armamentarium may allow for more complete resections of difficult intracerebral lesions while minimizing complications, such as visual deficit.