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S284: APPLICATION OF MULTIMODAL IMAGING INTEGRATING DIFFUSION TENSOR IMAGING (DTI) IN CRANIOPHARYNGIOMA: ENHANCING PREOPERATIVE SURGICAL PLANNING
Hongwei Yu¹; Yuanzhi Xu²; Haochen Yan¹; Qiaochu Liu¹; Cheng Gao¹; ¹Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China; ²Department of Neurosurgery, Stanford Hospital, Stanford, California

Objective: Accurate preoperative assessment—specifically determining the tumor's site of origin and its topological relationship with critical neurovascular structures such as the surrounding blood vessels, optic apparatus, pituitary stalk, and the floor of the third ventricle—is paramount for optimizing the surgical approach and reducing postoperative complications in craniopharyngioma surgery, particularly for the endonasal endoscopic route. This study investigates the utility of a multimodal imaging technique integrating Diffusion Tensor Imaging (DTI) in enhancing the precision of preoperative surgical planning for craniopharyngiomas.

Methods: We prospectively collected data from 19 patients undergoing surgery for craniopharyngioma. Preoperative thin-slice MRI, MRA, CT, and DTI data were acquired. Brainlab software was used for multimodal reconstruction and analysis of this imaging data. Tumor resection was performed using either an endonasal endoscopic approach or a craniotomy. Intraoperative findings were compared and statistically analyzed against the preoperative neuro-navigation system data.

Results: Analysis of the multimodal imaging data from the 19 patients demonstrated that the technique clearly delineated the spatial relationship between the tumor mass and the visual pathways, intracranial arteries, and ventricles, providing essential information for precisely mapping the tumor's invasion range. Crucially, DTI accurately visualized and mapped the pituitary stalk and the floor of the third ventricle, defining their topological relationship with the tumor. This comprehensive mapping significantly enhanced the precision of preoperative surgical planning, aiding in the selection of the optimal surgical trajectory. Intraoperatively, this precision was associated with a reduced incidence of damage to these critical neurovascular structures.

Conclusion: Multimodal imaging integrating DTI provides a comprehensive and precise basis for preoperative surgical planning in craniopharyngioma, offering key insights for selecting the best surgical approach. This guidance is vital for maximizing tumor resection while minimizing surgical morbidity. This technology's widespread application is poised to advance the precision and individualized nature of craniopharyngioma management.

Keywords: Craniopharyngioma; Diffusion Tensor Imaging (DTI); Multimodal Imaging; Surgical Planning; Preoperative Assessment

Figure: Multimodal Image Reconstruction Demonstrating the Topological Relationship between Craniopharyngioma and Surrounding Critical Structures. A-B: DTI Visualization showing the pituitary stalk is located posterolateral (or posterior and to the left) to the tumor. C-D: DTI Visualization showing the optic chiasm is located anterosuperior to the tumor. E-F: DTI Visualization showing the floor of the third ventricle is located superior to the tumor and appears intact. G-H: The three-dimensional (3D) reconstruction of the topological relationship is consistent with the intraoperative findings observed during the endoscopic endonasal approach (EEA).

 

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