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Intraoperative Visualization of White Matter Tracts During Brain Tumor Resection Haytham Elhawary, Ph. D Intraoperative Visualization of White Matter Tracts During Brain Tumor Resection Haytham Elhawary, Ph. D Postdoctoral Research Fellow March 19 th 2010

Intraoperative DTI Objectives • Increased survival is associated to increased tumor resection in both Intraoperative DTI Objectives • Increased survival is associated to increased tumor resection in both high and low grade gliomas • Minimize neurological deficits, so functional and anatomical information is required: f. MRI, DTI, T 1 w, T 2 w • Relation between white matter tracts, normal brain tissue and tumor • Objective is to develop a system that can allow visualization of white matter tracts in real-time during the intervention 2

Intraoperative DTI 3 Intraoperative DTI 3

Intraoperative DTI Methods • Tracked surgical tool from a navigation system sent to 3 Intraoperative DTI Methods • Tracked surgical tool from a navigation system sent to 3 D Slicer • VVLink and Open. IGTLink used to transfer data from Brainlab system to 3 D Slicer • Tool tip location used to create a fiducial point to seed DTI dataset using tractography. White matter tracts are visualized only in the surgical tool tip region 4

Intraoperative DTI Haytham Elhawary; Haiying Liu; Pratik Patel; Isaiah Norton; Laura Rigolo; Xenophon Papademetris; Intraoperative DTI Haytham Elhawary; Haiying Liu; Pratik Patel; Isaiah Norton; Laura Rigolo; Xenophon Papademetris; Nobuhiko Hata; Alexandra J. Golby, “Intra-operative Real-time Querying of White Matter Tracts during Frameless Stereotactic Neuronavigation”, Neurosurgery, under review 5

Intraoperative DTI Haytham Elhawary; Haiying Liu; Pratik Patel; Isaiah Norton; Laura Rigolo; Xenophon Papademetris; Intraoperative DTI Haytham Elhawary; Haiying Liu; Pratik Patel; Isaiah Norton; Laura Rigolo; Xenophon Papademetris; Nobuhiko Hata; Alexandra J. Golby, “Intra-operative Real-time Querying of White Matter Tracts during Frameless Stereotactic Neuronavigation”, Neurosurgery, under review 6

Intraoperative DTI 7 Intraoperative DTI 7

Intraoperative DTI Haytham Elhawary; Haiying Liu; Pratik Patel; Isaiah Norton; Laura Rigolo; Xenophon Papademetris; Intraoperative DTI Haytham Elhawary; Haiying Liu; Pratik Patel; Isaiah Norton; Laura Rigolo; Xenophon Papademetris; Nobuhiko Hata; Alexandra J. Golby, “Intra-operative Real-time Querying of White Matter Tracts during Frameless Stereotactic Neuronavigation”, Neurosurgery, under review 8

Intraoperative DTI 9 Intraoperative DTI 9

Intraoperative DTI 10 Intraoperative DTI 10

Intraoperative DTI Future Work • Overlay DTI visualization on to the microscope view (although Intraoperative DTI Future Work • Overlay DTI visualization on to the microscope view (although there are some problems) • Eliminate the Bio. Image Suite connection to reduce points of failure • Be able to pre-select only relevant clinical white mater tracts for visualization 11