覚醒下手術における術中ナビゲーションの活用

The Usefulness of the Intraoperative Neuronavigation System in Awake Surgery for Gliomas

Point

・覚醒下手術の成功の秘訣は，神経機能ネットワークの理解と術前の手術シミュレーションにある．

・皮質および白質の覚醒下マッピングにおいて，三次元トラクトグラフィが果たす役割は大きい．

・覚醒下手術におけるナビゲーションは，術中のみならず，術前シミュレーションにおいても重要なツールである．

　Awake surgery is a valuable surgical approach for gliomas, where the extent of resection and functional preservation significantly influence patient prognosis. To achieve safe and maximal resection, determining the resection area through neuronavigation and awake brain functional mapping is crucial. The three-dimensional (3D) virtual imaging model used for intraoperative navigation proves beneficial during surgery and in preoperative surgical simulation. These imaging models are primarily reconstructed by integrating 3D structural data depicting normal brain anatomy surrounding the lesion, 3D tractography visualizing the white matter neural network, and functional localization data obtained from functional magnetic resonance imaging (MRI）. The success of awake surgery relies heavily on a comprehensive understanding of the functional network of the brain and preoperative surgical simulation, with 3D tractography playing a pivotal role in strategizing awake mapping of the cortex and white matter. By correlating intraoperative findings from awake mapping with navigation data, including tractography and functional MRI, further advancements in understanding brain functional anatomy and its clinical applications are anticipated in the future.