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Corresponding author: James G. Malcolm, me@jgmalcolm.com

Monitoring Editor: Alexander Muacevic and John R Adler

The authors wish to thank Haley Harris, a clinical applications specialist with Synaptive Medical (Atlanta, GA), for help during the operative case and in preparing figures for publication.

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  • neurosurgery
  • meningioma
  • diffusion tensor imaging
  • synaptive
  • brainpath
  • intraventricular mass

Tractography for Optic Radiation Preservation in Transcortical Approaches to Intracerebral Lesions


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Open Access Case Report


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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.

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© Copyright 2017 Agarwal et al.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 3.0 Unported License (http://creativecommons.org/licenses/by/3.0/).

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