DTI for Facial Nerve Preoperative Prediction of Position and Course

  • Alberto Campione
  • Guglielmo Cacciotti
  • Raffaelino Roperto
  • Carlo Giacobbo Scavo
  • Luciano Mastronardi


The current strategy in vestibular schwannoma surgery dictates early intraoperative identification of the facial nerve by means of intraoperative monitoring. Imaging studies designed to trace the course of the facial nerve preoperatively should theoretically enhance surgical safety. The use of diffusion tensor tractography (DTT) for nerve tracking has evolved as a reliable technique in this regard. The latest systematic review available in the literature showed that complete tracking of the nerve’s course was obtained in 96.6% of cases and that surgical concordance with the preoperative DTT findings was obtained in 90.7%. The authors deemed preoperative DTT for facial nerve identification a useful adjunct in the surgical planning for large tumors (>2.5 cm). The application of tractography to detailed morphological reconstruction of the cranial nerves is a recent technology; therefore, it has potential limitations. These include a limited ability to distinguish the fibers of VII and VIII nerves, which could be overcome by combining DTT with specific MRI sequences.


Vestibular schwannoma/DTI Vestibular schwannoma/DTT Vestibular schwannoma/facial nerve Vestibular schwannoma/surgery 


  1. 1.
    Gerganov VM, Giordano M, Samii M, Samii A. Diffusion tensor imaging-based fiber tracking for prediction of the position of the facial nerve in relation to large vestibular schwannomas. J Neurosurg. 2011;115(6):1087–93.CrossRefGoogle Scholar
  2. 2.
    Taoka T, Hirabayashi H, Nakagawa H, Sakamoto M, Myochin K, Hirohashi S, et al. Displacement of the facial nerve course by vestibular schwannoma: preoperative visualization using diffusion tensor tractography. J Magn Reson Imaging. 2006;24(5):1005–10.CrossRefGoogle Scholar
  3. 3.
    Sartoretti-Schefer S, Kollias S, Valavanis A. Spatial relationship between vestibular schwannoma and facial nerve on three-dimensional T2-weighted fast spin-echo MR images. AJNR Am J Neuroradiol. 2000;21(5):810–6.PubMedGoogle Scholar
  4. 4.
    Chen DQ, Quan J, Guha A, Tymianski M, Mikulis D, Hodaie M. Three-dimensional in vivo modeling of vestibular schwannomas and surrounding cranial nerves with diffusion imaging tractography. Neurosurgery. 2011;68(4):1077–83.CrossRefGoogle Scholar
  5. 5.
    Savardekar AR, Patra DP, Thakur JD, Narayan V, Mohammed N, Bollam P, et al. Preoperative diffusion tensor imaging-fiber tracking for facial nerve identification in vestibular schwannoma: a systematic review on its evolution and current status with a pooled data analysis of surgical concordance rates. Neurosurg Focus. 2018;44(3):E5.CrossRefGoogle Scholar
  6. 6.
    Choi KS, Kim MS, Kwon HG, Jang SH, Kim OL. Preoperative identification of facial nerve in vestibular schwannomas surgery using diffusion tensor tractography. J Korean Neurosurg Soc. 2014;56(1):11–5.CrossRefGoogle Scholar
  7. 7.
    Hodaie M, Quan J, Chen DQ. In vivo visualization of cranial nerve pathways in humans using diffusion-based tractography. Neurosurgery. 2010;66(4):788–95; discussion 95–6.CrossRefGoogle Scholar
  8. 8.
    Zhang Y, Mao Z, Wei P, Jin Y, Ma L, Zhang J, et al. Preoperative prediction of location and shape of facial nerve in patients with large vestibular schwannomas using diffusion tensor imaging-based fiber tracking. World Neurosurg. 2017;99:70–8.CrossRefGoogle Scholar
  9. 9.
    Wei PH, Qi ZG, Chen G, Hu P, Li MC, Liang JT, et al. Identification of cranial nerves near large vestibular schwannomas using superselective diffusion tensor tractography: experience with 23 cases. Acta Neurochir (Wien). 2015;157(7):1239–49.CrossRefGoogle Scholar
  10. 10.
    Song F, Hou Y, Sun G, Chen X, Xu B, Huang JH, et al. In vivo visualization of the facial nerve in patients with acoustic neuroma using diffusion tensor imaging-based fiber tracking. J Neurosurg. 2016;125(4):787–94.CrossRefGoogle Scholar
  11. 11.
    Hilly O, Chen JM, Birch J, Hwang E, Lin VY, Aviv RI, et al. Diffusion tensor imaging tractography of the facial nerve in patients with cerebellopontine angle tumors. Otol Neurotol. 2016;37(4):388–93. Scholar
  12. 12.
    Ung N, Mathur M, Chung LK, Cremer N, Pelargos P, Frew A, et al. A systematic analysis of the reliability of diffusion tensor imaging tractography for facial nerve imaging in patients with vestibular schwannoma. J Neurol Surg B Skull Base. 2016;77(4):314–8.CrossRefGoogle Scholar
  13. 13.
    Dunn IF, Bi WL, Mukundan S, Delman BN, Parish J, Atkins T, et al. Congress of Neurological Surgeons systematic review and evidence-based guidelines on the role of imaging in the diagnosis and management of patients with vestibular schwannomas. Neurosurgery. 2018;82(2):E32–E4.CrossRefGoogle Scholar
  14. 14.
    Roundy N, Delashaw JB, Cetas JS. Preoperative identification of the facial nerve in patients with large cerebellopontine angle tumors using high-density diffusion tensor imaging. J Neurosurg. 2012;116(4):697–702.CrossRefGoogle Scholar
  15. 15.
    Yoshino M, Abhinav K, Yeh FC, Panesar S, Fernandes D, Pathak S, et al. Visualization of cranial nerves using high-definition fiber tractography. Neurosurgery. 2016;79(1):146–65.CrossRefGoogle Scholar
  16. 16.
    Li H, Wang L, Hao S, Li D, Wu Z, Zhang L, et al. Identification of the facial nerve in relation to vestibular schwannoma using preoperative diffusion tensor tractography and intraoperative tractography-integrated neuronavigation system. World Neurosurg. 2017;107:669–77.CrossRefGoogle Scholar
  17. 17.
    Yoshino M, Kin T, Ito A, Saito T, Nakagawa D, Ino K, et al. Combined use of diffusion tensor tractography and multifused contrast-enhanced FIESTA for predicting facial and cochlear nerve positions in relation to vestibular schwannoma. J Neurosurg. 2015;123(6):1480–8.CrossRefGoogle Scholar
  18. 18.
    Zolal A, Juratli TA, Podlesek D, Rieger B, Kitzler HH, Linn J, et al. Probabilistic tractography of the cranial nerves in vestibular schwannoma. World Neurosurg. 2017;107:47–53.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alberto Campione
    • 1
  • Guglielmo Cacciotti
    • 1
  • Raffaelino Roperto
    • 1
  • Carlo Giacobbo Scavo
    • 1
  • Luciano Mastronardi
    • 1
  1. 1.Department of NeurosurgerySan Filippo Neri Hospital—ASLRoma1RomeItaly

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