P12.46.A APPLICATION OF MULTIMODAL IMAGE THREE-DIMENSIONAL RECONSTRUCTION COMBINED WITH NEURONAVIGATION IN THE OPERATION OF GLIOMAS IN ELOQUENT REGIONS

Abstract BACKGROUND To investigate the role of three-dimensional reconstruction of multi-modal images combined with neuronavigation in the operation of gliomas in eloquent regions. MATERIAL AND METHODS A retrospective analysis was conducted on the clinical data of 30 patients with gliomas in eloquent regions who underwent surgical treatment at the Department of Neurosurgery of Peking University Third Hospital from April 2018 to March 2024. Before surgery, the patient’s skull MRI with enhancement, diffusion tensor imaging (DTI), and CT angiography (or magnetic resonance angiography) data were fused to reconstruct nerve tracts, tumors, blood vessels, skulls and other structures, so as to design the optimal surgical path, and used in neuronavigation to guide tumor resection. Degree of tumor resection was evaluated by using MRI results 72 hour post operation. One week, one month, and three months after surgery, the Boston Diagnostic Aphasia Examination (BDAE) was used to assess language function, and the simplified Fugl-Meyer Assessment (FMS) was used to assess motor function. RESULTS Through the three-dimensional image reconstruction, the anatomical relationship in all patients between the tumor and surrounding important structures such as nerve tracts, arteries and veins were clearly shown, the displacement and destruction of the nerve tracts were clarified, and the blood supply arteries and drainage veins were shown. Among the 30 patients, the tumor involved the motor area in 21 cases and language area in 25 cases. Totally resection was achieved in 28 cases (93.3%) and subtotal resection in 2 cases (6.7%). Among the 21 patients with preoperative neurological deficits, at the last follow-up, 20 patients had improved neurological function after surgery, and 1 patient had unchanged neurological function compared with presurgical conditions. Nine patients who had no neurological deficits before surgery developed transient symptoms related to neurological deficits after surgery, which resolved after 1 week. CONCLUSION The use of multimodal images to three-dimensionally reconstruct tumors and surrounding nerve fiber bundles, blood vessels and other important structures, so as to design surgical approaches and apply them to intraoperative navigation to guide the operation, could help protect the eloquent brain area and improve the efficacy of surgery.