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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (3): 530-535. doi: 10.19723/j.issn.1671-167X.2019.03.023

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Application of diffusion tensor imaging combined with virtual reality three-dimensional reconstruction in the operation of gliomas involved eloquent regions

Su-hua CHEN1,Jun YANG1△(),Hong-bin HAN2,3,De-hua CUI2,Jian-jun SUN1,Chang-cheng MA1,Qing-yuan HE2,3,Guo-zhong LIN1,Yun-feng HAN1,Chao WU1,Kai-ming MA1,Yi-bo ZHANG1   

  1. 1. Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
    2. Beijing Key Lab of Magnetic Resonance Imaging Device and Technique, Beijing 100191, China
    3. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2019-03-13 Online:2019-06-18 Published:2019-06-26
  • Supported by:
    Supported by the Fundamental Research Funds for the Central Universities: Peking University Clinical Scientist Program(BMU2019LCKXJ007), Clinical Key Project of Peking University third Hospital(BYSY2018060), The Clinical Research Project by Beijing Municipal Science&-Technology Commission(Z161100000516109), Program for Excellent Talents of Xicheng District(20180005)

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Abstract: Objective: To investigate the values of diffusion tensor imaging (DTI) and virtual reality(VR) techniques in design surgery program of gliomas near eloquent regions.Methods: In this study, 35 cases were retrospectively analyzed with gliomas involved language areas or rolandic regions operated in Department of Neurosurgery, Peking University Third Hospital from January 2015 to January 2019. Surgery programs were performed by Dextroscope virtual reality system. The pre-operative data, such as the magnetic resonance imaging(MRI), magnetic resonance arteriography (MRA) and DTI was transferred into the VR computer for restitution,Tumors, neural fiber tracts and blood vessels were reconstructed to simulate operation and design individual surgical plan. Neurological function was evaluated 1 week, 1 month and 3 months after operation.Results: Virtual reality three-dimensional images of the 35 cases were successfully achieved, including neural fiber tracts,blood vessels and the lesions. The displacement and destruction of fiber tracts,the anatomic relationship between tumor and important fiber bundle, artery and vein could be shown clearly. Surgical simulation and surgery program of VR of the 35 patients were successfully performed. The 3D images obtained from virtual reality near to the real surgery. Ten of the 35 cases were defined as rolandic regions tumors, 14 of the 35 cases were defined as language areas tumors and 11 of the 35 cases involved both language areas and rolandic regions. Complete resection of enhancing tumor (CRET) was achieved in 30 cases (85.7%), subtotal resection in 5 cases (14.3%), neurological function improved in 34 cases (97.1%) after operation,and 1 case had no improvement compared with that before(2.9%). Thirteen cases without neurological deficit pre-operation,showed transient neurological deficit ,which were recovered about 10 days post-operation, 12 of 22 cases with pre-operative neurologic deficit, improved one week postoperation, 9 of 22 cases with pre-operative neurologic deficit improved one month after operation, the rest 1 case was recurrent with glioblastoma with aggravated hemiplegia symptom after operation, who died of cerebral hernia 2 months later.Conclusion: Dextroscope virtual reality system can clearly expose and quantify the 3D anatomic relationship of tumors, neural fiber tracts and blood vessels surrounding gliomas near eloquent regions, which is helpful to design the best individualized surgery program, to improve surgical effect.

Key words: Gliomas, Eloquent regions, Diffusion tensor imaging, Virtual reality, Three-dimensional reconstruction

CLC Number: 

  • R651.1

Figure 1

Gliomas in left frontal lobe (female, 49 years old, aphasia for 5 months) A, enhanced magnetic resonance imaging showed the space occupying lesion in left frontal lobe with no enhancement; B, left view, reconstruction of tumor and diffusion tensor imaging, light blue shows fibers of the middle frontal gyrus, pink shows fiber of anterior central gyrus, purple shows fibers of inferior frontal gyrus, and green shows the tumor, the tumor invades the middle frontal gyrus fiber, fibers of the tumor surface is sparse. The yellow ellipse shows the recommended position of surgical approach; C, left view, dark blue shows the sylvian vein and sigmoid sinus, the venous outflow of tumors are mainly drained into the sylvian vein, which is close to the location of approach,and should be protected carefully during the operation; D, right view, red shows the artery, branches of the middle cerebral artery envelop the tumor and are feeding vessels, which should be protected carefully during the operation, red arrow shows a satellite lesion of the tumor; E, left view, yellow ellipse shows the recommended position of surgical approach, where nerve fibers are sparse, with no arterial branches and veins acrossing; F, enhanced MRI of 1 week after operation suggests a total resection of the tumor."

Figure 2

Glioma in left paracentral lobule (male, 58 years old, activity adverse of the right limbs for half a year) A, superior view, it shows the relationship of the tumor and the arteries, green shows the tumor, red shows the arteries, the anterior cerebral arteries envelop the tumor; B, right view, it shows the relationship between tumor and vein and sinus, dark blue shows veins,which suggests that tumor locates closely nearby the inferior sagittal sinus, choroid plexus and communicating branches between superior sagittal sinus and inferior sagittal sinus, these veins should be protected during operation; C, posterior view, it shows the relationship of the tumor and the left corticospinal tracts, and the tumor is near but has not yet invaded the corticospinal tracts; D, anterior view,it shows the relationship of the tumor and fibers of the left paracentric lobule, purple shows the paracentric lobular fibers, which suggests that the tumor is surrounded by the paracentric lobular fibers in three directions: the anterior, inner and outer sides; E, left view, it shows no important fibers behind the tumor, red triangle shows the recommended surgical approach; F, upper view, it shows the relationship of the surgical approach and the superior sagittal sinus, yellow ellipse shows the recommended location of surgical approach."

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