Honing the surgical corridors: Diffusion imaging tractography guided single-fraction stereotactic radiosurgery for stroke managements in middle east countries

Abstract

Introduction Stroke or cerebrovascular accident (CVA) is a sudden occurrence, focal and non-convulsive neurologic deficit [1]. In recent analysis (N=1541), spontaneous intracerebral haemorrhage (ICH), patients with intermediate Glasgow Coma Scale (GCS) between 9 to 12 may benefit from surgery, whereas those with higher or lower GCS may not [2]. Why middle east? According to WHO, every-year there were 10.3 million new cases and, overall high prevalence of 67% Ischemic strokes (IC) (Fig. 1) were observed in Middle East countries. Also, the incidence rate for females were high when compared to male [3]. Future directions The tissue plasminogen activator (tPA) is the only approved medication for IS, which must be administered within a three-hour space from the onset of symptoms for recovering results. Unfortunately, only 3- 5 percent reach the hospital in time, and the actual use of tPA is considerably low. This tPA also carries risk of increased intracranial hemorrhage so it is not used for haemorrhagic stroke [4]. Management with surgery opted as least priority, because surgery benefits some and harms others [2]. Approach selection The integration of stereotactic diffusion tensor imaging (DTI) tractography (Fig. 2) with Gamma Knife radiosurgery (GKRS) has increased therapeutic potential and safety [5]. The procedure affects white matter tracts (predominantly the optic radiation and fasciculus - arcuate) are more vulnerable to radiation during stereotactic radiosurgery. Conclusion Integration of stereotactic tractography into Single-fraction stereotactic radiosurgery (SF-SRS) represents a promising tool for preventing the surgical complications in white matter tracts [6].