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Author Notes:

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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Do not disregard or avoid professional medical advice due to content published within Cureus.

Consent was obtained by all participants in this study

The authors have declared that no competing interests exist.

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Keywords:

  • 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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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.

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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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