Study on diffusion tensor imaging combined with electrophysiological monitoring in brain stem cavernous hemangioma resection

Abstract

Objective To evaluate the clinical application value of diffusion tensor imaging (DTI) combined with electrophysiological monitoring in the resection of brain stem cavernous hemangioma (CM). Methods There were 39 patients with brain stem cavernous hemangioma. DTI was performed before and during the operation. Diffusion tensor tractography (DTT) was used to track fiber and reconstruct pyramidal tract. Intraoperative neurobehavioral monitoring was used to detect the changes of somatosensory-evoked potentials (SEP), motor - evoked potentials (MEP) and brain stem auditory - evoked potentials (BAEP). Results Of all the 39 patients, there was no significant change of BAEP during the operation, 5 patients (12.82%) had abnormal SEP, 6 cases (15.38%) had abnormalities in MEP monitoring, 2 cases (5.13%) had reduced volumes of pyramidal tract proved by DTI. Intraoperative MRI confirmed 36 cases (92.31%) had complete removal of lesions, and 3 cases (7.69% ) had subtotal resection. There were improvement of clinical symptoms in 29 cases (74.36% ), no obvious changes in 4 cases (10.26% ), postoperative facial paralysis in 3 cases (7.69%), worsened movement disorder in 2 cases (5.13%), death due to disorder of consciousness and pulmonary infection in one case (2.56% ). Postoperative follow - up was 30 months in average. Glasgow Outcome Scale (GOS) showed 27 cases (69.23%) of Grade 5, 7 cases (17.95%) of Grade 4, 4 cases (10.26% ) of Grade 3, and one case (2.56% ) of Grade 1. Conclusions Combined use of intraoperative DTI and electrophysiological monitoring can safely and effectively remove brain stem cavernous hemangioma. DOI: 10.3969/j.issn.1672-6731.2017.05.010

Keywords

• Hemangioma, cavernous, central nervous system
• Brain stem
• Magnetic resonance imaging
• Evoked potentials
• Neurosurgical procedures