Cranial nerve tractography

Cranial nerve tractography

Diffusion imaging tractography caught the attention of the scientific community by describing the white matter architecture in vivo and noninvasively, but its application to small structures such as cranial nerves remains difficult. The few attempts to track cranial nerves presented highly variable acquisition and tracking settings.

A “targeted” review of the scientific literaturewas carried out using the MEDLINEdatabase.

Jacquesson et al., selected studies that reported how to perform the tractography of cranial nerves, and extracted the following: clinical context; imaging acquisition settings; tractography parameters; regions of interest (ROIs) design; and filtering methods.

Twenty-one published articles were included. These studied the optic nerves in suprasellar tumors, the trigeminal nerve in neurovascular conflicts, the facial nerve position around vestibular schwannomas, or all cranial nerves. Over time, the number of MRI diffusion gradient directions increased from 6 to 101. Nine tracking software packages were used which offered various types of tridimensional display. Tracking parameters were disparately detailed except for fractional anisotropy, which ranged from 0.06 to 0.5, and curvature angle, which was set between 20° and 90°. ROI design has evolved towards a multi-ROI strategy. Furthermore, new algorithms are being developed to avoid spurious tracts and improve angular resolution.

This review highlights the variability in the settings used for cranial nerve tractography. It points out challenges that originate both from cranial nerve anatomy and the tractography technology, and allows a better understanding of cranial nerve tractography 1).

Case series

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.

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.

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 2).


Visualization of Cranial Nerves Using High-Definition Fiber Tractography



Jacquesson T, Frindel C, Kocevar G, Berhouma M, Jouanneau E, Attyé A, Cotton F. Overcoming Challenges of Cranial Nerve Tractography: A Targeted Review. Neurosurgery. 2019 Feb 1;84(2):313-325. doi: 10.1093/neuros/nyy229. PubMed PMID: 30010992.

Yoshino M, Abhinav K, Yeh FC, Panesar S, Fernandes D, Pathak S, Gardner PA, Fernandez-Miranda JC. Visualization of Cranial Nerves Using High-Definition Fiber Tractography. Neurosurgery. 2016 Jul;79(1):146-65. doi: 10.1227/NEU.0000000000001241. PubMed PMID: 27070917.

EANS Basic Course in Cranial Surgery – Brno

EANS Basic Course in Cranial Surgery – Brno

Message from Course Chairmen Prof. Torstein R. Meling and Prof. Martin Smrcka:

It is our pleasure to welcome you to the second EANS Basic Course in Cranial Surgery in Brno. The event will be held from 20th to 23rd November 2018 and is organized in the Masaryk University Brno, Czech Republic. 

This dissection course is most suitable for neurosurgical residents in their first years of training as it will focus on the essential neurosurgical anatomy, the planning of surgical procedures, the handling of basic neurosurgical equipment, and the basic neurosurgical cranial approaches. The course capacity is limited to 20 participants.

Course dates:
 20 November (arrive in time for welcome dinner) – 23 November 2018

 The course will take place at Masaryk University Brno, Faculty of Medicine, Anatomy Institute, Kamenice 3, 62500 Brno, Czech Republic

Target audience:
 All levels, but of the most benefit for neurosurgical residents in their first years of training.

 Participants will learn the essential neurosurgical anatomy, the planning of surgical procedures, the handling of basic neurosurgical equipment, and the basic neurosurgical cranial approaches. Please click HERE for a more complete list.

Download the premliminary programme HERE.

2018 Faculty:

Course chairmen: T Meling (NO) / M Smrcka (CZ)

J Fiedler (CZ)
O Navratil (CZ)
V Priban (CZ)
S Rocka (LT)
M Sames (CZ)
E Simon (FR)
V Smolanka (UA)
N Velinov (BG)

Course Fee:

EANS Individual Member: €1150
Non-Member: €1250

The fee includes all tuition costs, subsistence during the course (lunches and coffee breaks) and the networking events listed below. Scrubs are provided. The fee does NOT include accommodation (please see accommodation suggestions below).

Networking opportunities:
 Welcome cocktail on Tuesday 20th November evening and Networking Dinner on Thursday 22nd November. Participants are free to make their own arrangements on Wednesday night.

Cancellation policy:
Cancellations received in writing before 20 days prior to the course start will be reimbursed.
Cancellations between 20 and 10 days prior to the course – minimum 50% refund.
Cancellations less than 10 days prior to the course – no refund (unless exceptional extenuating circumstances).

Accommodation suggestions:
 Campea Aparthotel, Studentská 1, Brno, 62500 –

Travel: Brno has an international airport with particularly good connections to the UK (London Stansted and Luton) and Germany (Münich).

Participants can also arrive at either Vienna or Prague airports and take the train to Brno (slightly shorter transfer time from Vienna).

Please contact Petra Koubova for all inquiries.


First EANS Brno HandsOn Course

The inaugural EANS Brno HandsOn Course took place from 28 November to 1 December 2017, led by Course Chairmen, EANS Training Committee Chair Torstein Meling and Chief of Neurosurgery Department of University Hospital Brno Martin Smrcka.

The format was immediately successful and received excellent evaluations from the participations. Please see the testimonials below.

All the attendees were hard working and enthusistic. The atmosphere was serious while working but in free time we made friends and had fun:-)

I want to thank you for this course. It was great! Maybe it can be even better if we have a little bit more time for our approaches. Because, while we are residents, we really like do it precisely like it was discussed. And maybe we are not fast enough sometimes. Also I want to mention that we had some problems with brain tissue during our dissections. I understand that’s mostly because of the cadaveric status of the brain, but still if there is a way to improve it – it will even better than now. And I really want to thank all the faculty members. You were super friendly and useful during this course. I can’t wait to meet you once again. Thank you! Thank you so much for everything, enjoyed every second.

It was absolutely great! And I wish you all the best!

Good timing, everything was well balanced, maybe a bit more time for dissections.

It was amazing how the faculty was interested and enjoyed the time with us. And how they helped, gave advice…

Applied Cranial-Cerebral Anatomy: Brain Architecture and Anatomically Oriented Microneurosurgery

Applied Cranial-Cerebral Anatomy: Brain Architecture and Anatomically Oriented Microneurosurgery

List Price: 
This book is the first to offer a comprehensive guide to understanding the brain’s architecture from a topographical viewpoint. Authored by a leading expert in surgical neuroanatomy, this practical text provides tri-dimensional understanding of the cerebral hemispheres, and the relationships between cerebral surfaces and the skull’s outer surfaces through detailed brain dissections and actual clinical cases with operative photographs and correlative neuroimaging. For neurosurgeons, neuroradiologists and neurologists at all levels, this book emphasises the anatomy of the sulci and gyri of the cerebral surface. It is an essential resource for the general neurosurgery practice, and more particularly for planning surgical access routes for intracranial tumors.

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