Preoperative diffusion tensor imaging-fiber tracking for facial nerve identification in vestibular schwannoma: a systematic review on its evolution and current status with a pooled data analysis of surgical concordance rates.
Neurosurg Focus
; 44(3): E5, 2018 03.
Article
em En
| MEDLINE
| ID: mdl-29490547
ABSTRACT
OBJECTIVE Total tumor excision with the preservation of neurological function and quality of life is the goal of modern-day vestibular schwannoma (VS) surgery. Postoperative facial nerve (FN) paralysis is a devastating complication of VS surgery. Determining the course of the FN in relation to a VS preoperatively is invaluable to the neurosurgeon and is likely to enhance surgical safety with respect to FN function. Diffusion tensor imaging-fiber tracking (DTI-FT) technology is slowly gaining traction as a viable tool for preoperative FN visualization in patients with VS. METHODS A systematic review of the literature in the PubMed, Cochrane Library, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and those studies that preoperatively localized the FN in relation to a VS using the DTI-FT technique and verified those preoperative FN tracking results by using microscopic observation and electrophysiological monitoring during microsurgery were included. A pooled analysis of studies was performed to calculate the surgical concordance rate (accuracy) of DTI-FT technology for FN localization. RESULTS Fourteen studies included 234 VS patients (male/female ratio 11.4, age range 17-75 years) who had undergone preoperative DTI-FT for FN identification. The mean tumor size among the studies ranged from 29 to 41.3 mm. Preoperative DTI-FT could not visualize the FN tract in 8 patients (3.4%) and its findings could not be verified in 3 patients (1.2%), were verified but discordant in 18 patients (7.6%), and were verified and concordant in 205 patients (87.1%). CONCLUSIONS Preoperative DTI-FT for FN identification is a useful adjunct in the surgical planning for large VSs (> 2.5 cm). A pooled analysis showed that DTI-FT successfully identifies the complete FN course in 96.6% of VSs (226 of 234 cases) and that FN identification by DTI-FT is accurate in 90.6% of cases (205 of 226 cases). Larger studies with DTI-FT-integrated neuronavigation are required to look at the direct benefit offered by this specific technique in preserving postoperative FN function.
Palavras-chave
CE-FIESTA = contrast-enhanced FIESTA; CPA = cerebellopontine angle; DTI = diffusion tensor imaging; DTT = diffusion tensor tractography; FA = fractional anisotropy; FIESTA = fast imaging employing steady-state acquisition; FN = facial nerve; FT = fiber tracking; IAC = internal auditory canal; ROI = region of interest; VS = vestibular schwannoma; acoustic neuroma; cerebellopontine angle tumor; diffusion tensor imaging; diffusion tensor tractography; facial nerve fiber tracking; preoperative facial nerve imaging; preoperative facial nerve tractography; vestibular schwannoma
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cuidados Pré-Operatórios
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Neuroma Acústico
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Nervo Facial
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Imagem de Tensor de Difusão
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Análise de Dados
Tipo de estudo:
Diagnostic_studies
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Prognostic_studies
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Systematic_reviews
Limite:
Humans
Idioma:
En
Revista:
Neurosurg Focus
Assunto da revista:
NEUROCIRURGIA
Ano de publicação:
2018
Tipo de documento:
Article