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Visualization of Cranial Nerves Using High-Definition Fiber Tractography

Yoshino, Masanori MD, PhD; Abhinav, Kumar MD; Yeh, Fang-Cheng MD, PhD; Panesar, Sandip MD; Fernandes, David MD; Pathak, Sudhir MS; Gardner, Paul A. MD; Fernandez-Miranda, Juan C. MD

doi: 10.1227/NEU.0000000000001241
Concepts, Innovations and Techniques

BACKGROUND: Recent studies have demonstrated diffusion tensor imaging tractography of cranial nerves (CNs). Spatial and angular resolution, however, is limited with this modality. A substantial improvement in image resolution can be achieved with high-angle diffusion magnetic resonance imaging and atlas-based fiber tracking to provide detailed trajectories of CNs.

OBJECTIVE: To use high-definition fiber tractography to identify CNs in healthy subjects and patients with brain tumors.

METHODS: Five neurologically healthy adults and 3 patients with brain tumors were scanned with diffusion spectrum imaging that allowed high-angular-resolution fiber tracking. In addition, a 488-subject diffusion magnetic resonance imaging template constructed from the Human Connectome Project data was used to conduct atlas space fiber tracking of CNs.

RESULTS: The cisternal portions of most CNs were tracked and visualized in each healthy subject and in atlas fiber tracking. The entire optic radiation, medial longitudinal fasciculus, spinal trigeminal nucleus/tract, petroclival portion of the abducens nerve, and intrabrainstem portion of the facial nerve from the root exit zone to the adjacent abducens nucleus were identified. This suggested that the high-angular-resolution fiber tracking was able to distinguish the facial nerve from the vestibulocochlear nerve complex. The tractography clearly visualized CNs displaced by brain tumors. These tractography findings were confirmed intraoperatively.

CONCLUSION: Using high-angular-resolution fiber tracking and atlas-based fiber tracking, we were able to identify all CNs in unprecedented detail. This implies its potential in localization of CNs during surgical planning.

ABBREVIATIONS: CN, cranial nerve

DSI, diffusion spectrum imaging

DTI, diffusion tensor imaging

HCP, Human Connectome Project

HDFT, high-definition fiber tractography

MLF, medial longitudinal fasciculus

ODF, orientation distribution function

ROI, region of interest

*Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;

Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania;

§Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania

Correspondence: Juan C. Fernandez-Miranda, MD, Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, 200 Lothrop St, PUH B-400, Pittsburgh, PA 15213. E-mail:

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Received June 08, 2015

Accepted February 11, 2016

Copyright © by the Congress of Neurological Surgeons