The use of DTI in the differentiation and surgical planning of suprasellar hypothalamic-opticochiasmatic glioma and craniopharyngioma in children.

in World neurosurgery by Shuang Li, Wenjiao Xiao, Zanyong Tong, Lusheng Li, Yuting Zhang

TLDR

  • The study found that fiber tractography can help doctors differentiate between two types of brain tumors that are hard to tell apart on regular MRI. The study also showed that fiber tractography can help doctors plan surgeries without damaging important parts of the brain, which can improve patients' chances of surviving and living without any long-term problems.

Abstract

Suprasellar hypothalamic-opticochiasmatic glioma (HOCG) and craniopharyngioma (CP) have similar appearances on conventional MRI and are difficult to distinguish. Moreover, these tumors are situated near vital structures like the optic chiasm and hypothalamus, rendering conventional surgery susceptible to significant complications. We mainly discussed the surgical application value and diagnostic value of diffusion tensor imaging (DTI) in HOCG and CP. The retrospective analysis of 13 cases of HOCG and 16 cases of CP was conducted. All patients underwent conventional MRI and DTI prior to surgery, and were pathologically diagnosed postoperatively. Both CP and HOCG appeared as heterogeneous mixed signal masses on conventional MRI. For HOCGs, fiber tractography revealed two different growth patterns of the tumor: infiltrative type and inflated type. The surgical approach and risk levels differ between these growth patterns. Additionally, fiber tractography demonstrates significant differences compared to CPs. The surgical approach and extent of resection for all cases of these two tumors were guided by DTI. DTI enhances the accuracy of HOCG and CP differentiation. Furthermore, patterns of tractography described in this study assist neurosurgeons in delineating the surgical pathway and tumor resection range without damaging important fiber bundles, thereby avoiding permanent neurological deficits and improving survival quality for patients.

Overview

  • The study aims to investigate the surgical application value and diagnostic value of diffusion tensor imaging (DTI) in suprasellar hypothalamic-opticochiasmatic glioma (HOCG) and craniopharyngioma (CP).
  • The study retrospectively analyzed 13 cases of HOCG and 16 cases of CP. All patients underwent conventional MRI and DTI prior to surgery and were pathologically diagnosed postoperatively. Both CP and HOCG appeared as heterogeneous mixed signal masses on conventional MRI. For HOCGs, fiber tractography revealed two different growth patterns of the tumor: infiltrative type and inflated type. The surgical approach and risk levels differ between these growth patterns. Additionally, fiber tractography demonstrates significant differences compared to CPs. The surgical approach and extent of resection for all cases of these two tumors were guided by DTI. DTI enhances the accuracy of HOCG and CP differentiation. Patterns of tractography described in this study assist neurosurgeons in delineating the surgical pathway and tumor resection range without damaging important fiber bundles, thereby avoiding permanent neurological deficits and improving survival quality for patients.

Comparative Analysis & Findings

  • The study found that fiber tractography revealed two different growth patterns of HOCGs: infiltrative type and inflated type. The surgical approach and risk levels differ between these growth patterns. Additionally, fiber tractography demonstrated significant differences compared to CPs. The surgical approach and extent of resection for all cases of these two tumors were guided by DTI. DTI enhances the accuracy of HOCG and CP differentiation. Patterns of tractography described in this study assist neurosurgeons in delineating the surgical pathway and tumor resection range without damaging important fiber bundles, thereby avoiding permanent neurological deficits and improving survival quality for patients.

Implications and Future Directions

  • The study highlights the importance of DTI in differentiating HOCG and CP, which are difficult to distinguish on conventional MRI. The findings suggest that fiber tractography can assist neurosurgeons in delineating the surgical pathway and tumor resection range without damaging important fiber bundles, thereby avoiding permanent neurological deficits and improving survival quality for patients. Future research should focus on expanding the use of DTI in the surgical management of HOCG and CP, as well as exploring its potential in other brain tumors. Additionally, further studies are needed to validate the findings of this study and to determine the optimal DTI parameters for differentiating HOCG and CP.
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