No definitive method of preventing visual field deficits after stereotactic radiosurgery for lesions near the optic radiation (OR) has been available so far. The authors report the results of integrating OR tractography based on diffusion tensor (DT) magnetic resonance imaging into simulated treatment planning for Gamma Knife surgery (GKS).
开云体育世界杯赔率
Data from imaging studies performed in 10 patients who underwent GKS for treatment of arteriovenous malformations (AVMs) located adjacent to the OR were used for the simulated treatment planning. Diffusion tensor images performed without the patient's head being secured by a stereotactic frame were used for DT tractography, and the OR was visualized by means of software developed by the authors. Data from stereotactic 3D imaging studies performed after frame fixation were coregistered with the data from DT tractography. The combined images were transferred to a GKS treatment-planning workstation. Delivered doses and distances between the treated lesions and the OR were analyzed and correlated with posttreatment neurological changes.
Results
In patients presenting with migraine with visual aura or occipital lobe epilepsy, the OR was located within 11 mm from AVMs. In a patient who developed new quadrantanopia after GKS, the OR had received 32 Gy. A maximum dose to the OR of less than 12 Gy did not cause new visual field deficits. A maximum dose to the OR of 8 Gy or more was significantly related to neurological change (p < 0.05), including visual field deficits and development or improvement of migraine.
Conclusions
Integration of OR tractography into GKS represents a promising tool for preventing GKS-induced visual disturbances and headaches. Single-session irradiation at a dose of 8 Gy or more was associated with neurological change.
Abbreviations used in this paper:
AVM = arteriovenous malformation;CT = computed tomography;DICOM = Digital Imaging and Communications in Medicine;DT = diffusion tensor;GKS = Gamma Knife surgery;MR = magnetic resonance;OR = optic radiation.
Address correspondence to: Keisuke Maruyama, M.D., Ph.D., Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. email:kskmaru-tky@umin.ac.jp.
Catani
M
,
Jones
DK
,
Donato
R
,
Ffytche
DH
:
Occipito-temporal connections in the human brain
.Brain
126
:
2093
–
2107
,
2003
10.1093/brain/awg203)| false
KamadaK,,TodoT,,MasutaniY,,AokiS,,InoK,&TakanoT,et al.:Combined use of tractography-integrated functional neuronavigation and direct fiber stimulation.J Neurosurg102:664–672,2005
Kamada
K
,
Todo
T
,
Masutani
Y
,
Aoki
S
,
Ino
K
,
Takano
T
,
:
Combined use of tractography-integrated functional neuronavigation and direct fiber stimulation
.J Neurosurg
102
:
664
–
672
,
2005
10.3171/jns.2005.102.4.0664)| false
KamadaK,,TodoT,,MoritaA,,MasutaniY,,AokiS,&InoK,et al.:Functional monitoring for visual pathway using real-time visual evoked potentials and optic-radiation tractography.开云体育app官方网站下载入口57:1 Suppl121–127,2005
Kamada
K
,
Todo
T
,
Morita
A
,
Masutani
Y
,
Aoki
S
,
Ino
K
,
:
Functional monitoring for visual pathway using real-time visual evoked potentials and optic-radiation tractography
.开云体育app官方网站下载入口
57
:
1 Suppl
121
–
127
,
2005)| false
KierEL,,StaibLH,,DavisLM,&BronenRA:MR imaging of the temporal stem: anatomic dissection tractography of the uncinate fasciculus, inferior occipitofrontal fasciculus, and Meyer's loop of the optic radiation.AJNR Am J Neuroradiol25:677–691,2004
Kier
EL
,
Staib
LH
,
Davis
LM
,
Bronen
RA
:
MR imaging of the temporal stem: anatomic dissection tractography of the uncinate fasciculus, inferior occipitofrontal fasciculus, and Meyer's loop of the optic radiation
.AJNR Am J Neuroradiol
25
:
677
–
691
,
2004)| false
KikutaK,,TakagiY,,NozakiK,,HanakawaT,,OkadaT,&MikiY,et al.:Early experience with 3-t magnetic resonance tractography in the surgery of cerebral arteriovenous malformations in and around the visual pathway.开云体育app官方网站下载入口58:331–337,2006
Kikuta
K
,
Takagi
Y
,
Nozaki
K
,
Hanakawa
T
,
Okada
T
,
Miki
Y
,
:
Early experience with 3-t magnetic resonance tractography in the surgery of cerebral arteriovenous malformations in and around the visual pathway
.开云体育app官方网站下载入口
58
:
331
–
337
,
2006
10.1227/01.NEU.0000195017.82776.90)| false
Kurita
H
,
Ueki
K
,
Shin
M
,
Kawamoto
S
,
Sasaki
T
,
Tago
M
,
:
Headaches in patients with radiosurgically treated occipital arteriovenous malformations
.J Neurosurg
93
:
224
–
228
,
2000
10.3171/jns.2000.93.2.0224)| false
LeberKA,,BerglöffJ,&PendlG:Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery.J Neurosurg88:43–50,1998
Leber
KA
,
Berglöff
J
,
Pendl
G
:
Dose-response tolerance of the visual pathways and cranial nerves of the cavernous sinus to stereotactic radiosurgery
.J Neurosurg
88
:
43
–
50
,
1998
10.3171/jns.1998.88.1.0043)| false
MaruyamaK,,KamadaK,,ShinM,,ItohD,,AokiS,&MasutaniY,et al.:Integration of three-dimensional corticospinal tractography into treatment planning for gamma knife surgery.J Neurosurg102:673–677,2005
Maruyama
K
,
Kamada
K
,
Shin
M
,
Itoh
D
,
Aoki
S
,
Masutani
Y
,
:
Integration of three-dimensional corticospinal tractography into treatment planning for gamma knife surgery
.J Neurosurg
102
:
673
–
677
,
2005
10.3171/jns.2005.102.4.0673)| false
MaruyamaK,,KawaharaN,,ShinM,,TagoM,,KishimotoJ,&KuritaH,et al.:The risk of hemorrhage after radiosurgery for cerebral arteriovenous malformations.N Engl J Med352:146–153,2005
Maruyama
K
,
Kawahara
N
,
Shin
M
,
Tago
M
,
Kishimoto
J
,
Kurita
H
,
:
The risk of hemorrhage after radiosurgery for cerebral arteriovenous malformations
.N Engl J Med
352
:
146
–
153
,
2005
10.1056/NEJMoa040907)| false
MaruyamaK,,ShinM,,TagoM,,KuritaH,,KawamotoS,&MoritaA,et al.:Gamma knife surgery for arteriovenous malformations involving the corpus callosum.J Neurosurg102:Suppl49–52,2005
Maruyama
K
,
Shin
M
,
Tago
M
,
Kurita
H
,
Kawamoto
S
,
Morita
A
,
:
Gamma knife surgery for arteriovenous malformations involving the corpus callosum
.J Neurosurg
102
:
Suppl
49
–
52
,
2005
10.3171/sup.2005.102.s_supplement.0049)| false
MasutaniY,,AokiS,,AbeO,,HayashiN,&OtomoK:MR diffusion tensor imaging: recent advance and new techniques for diffusion tensor visualization.Eur J Radiol46:53–66,2003
Masutani
Y
,
Aoki
S
,
Abe
O
,
Hayashi
N
,
Otomo
K
:
MR diffusion tensor imaging: recent advance and new techniques for diffusion tensor visualization
.Eur J Radiol
46
:
53
–
66
,
2003
10.1016/S0720-048X(02)00328-5)| false
