• Masanori Yoshino, Kumar Abhinav, Fang-Cheng Yeh, Sandip Panesar, David Fernandes, Sudhir Pathak, Paul A Gardner, and Juan C Fernandez-Miranda.
• *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.
• Neurosurgery. 2016 Jul 1; 79 (1): 146-65.

BackgroundRecent 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.ObjectiveTo use high-definition fiber tractography to identify CNs in healthy subjects and patients with brain tumors.MethodsFive 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.ResultsThe 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.ConclusionUsing 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.AbbreviationsCN, cranial nerveDSI, diffusion spectrum imagingDTI, diffusion tensor imagingHCP, Human Connectome ProjectHDFT, high-definition fiber tractographyMLF, medial longitudinal fasciculusODF, orientation distribution functionROI, region of interest.

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