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  • Applications of Ascending Reticular Activating System Reconstruction with DTI Tractography in Neurosurgery. Case-Based Illustrations

    Final Number:

    Edgar Gerardo Ordonez-Rubiano MD; Jorge H Marin-Munoz; Cesar Enciso; Edgar Ordonez-Mora MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Different applications of white matter tracts with DTI tractography have been demonstrated in the past 2 decades. Depuration of withe matter tracts anatomy has made a more precise approach to different pathways in the brainstem. The beautiful depiction of the Ascending Reticular Activating System (ARAS) with DTI tractography has allowed us to investigate different aspects of consciousness in neurosurgical entities. This work aims to describe different uses of this reconstruction in neurosurgery.

    Methods: Different patients with brainstem tumor and trauma lesions with impaired consciousness were selected. Complete reconstruction of the ARAS with 1.5 and 3 tesla were performed. Post-processing of images was performed with different software including GE, Braviz and FiberNavigator.

    Results: Surgical and non-surgical cases are shown, demonstrating the use for determining whether to operate or to lead conservative management in patients with impaired consciousness. Trauma patients showed destruction of fibers, leading patients to conservative management. In the other hand, patients with brainstem cavernomas showed patency of the ARAS fibers, and posteriorly showed improvement of the altered consciousness.

    Conclusions: The reconstruction of the ARAS with tractography allows neurosurgeons to determine the patency of the fibers, decide which approach would be more safe for brainstem cavernomas resection and verify the patency of ARAS fibers in patients with diffuse axonal injury after TBI.

    Patient Care: Make correlations of the anatomy of the ARAS in patients with impaired consciousness. To improve understanding of alteration of consciousness in patients with neurosurgical entities.

    Learning Objectives: By the conclusión of this session, participante should be able to describe the uses of ARAS fibers reconstruction with tractography in neurosurgery, describe the use for brainstem cavernomas and the use for patients with difusse axonal injury.

    References: 1. Edlow BL, Takahashi E, Wu O, et al. Neuroanatomic connectivity of the human ascending arousal system critical to consciousness and its disorders. J Neuropathol Exp Neurol. 2012;71(6):531-546. 2. Steriade M, Glenn LL. Neocortical and caudate projections of intralaminar thalamic neurons and their synaptic excitation from midbrain reticular core. J Neurophysiol. 1982;48(2):352-371. 3. Steriade M. Arousal: revisiting the reticular activating system. Science. 1996;272(5259):225-226.

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