Diffusion tractography: methods, validation and applications in patients with neurosurgical lesions

Area of Science:

• Neurosurgery
• Medical Imaging
• Neuroscience

Background:

• Presurgical mapping is critical for tumors in eloquent brain areas.
• Diffusion Tensor Imaging (DTI) tractography provides non-invasive in vivo visualization of white matter tracts.
• Accurate presurgical planning improves surgical outcomes and reduces neurological deficits.

Purpose of the Study:

• To review the capabilities and limitations of DTI tractography for intraoperative mapping of brain tumors.
• To provide an overview of the current knowledge regarding DTI's role in neurosurgery.

Main Methods:

• Review of existing literature on DTI tractography in neuro-oncology.
• Analysis of studies comparing DTI findings with intraoperative mapping results.
• Discussion of technical and tumor-related factors influencing DTI accuracy.

Main Results:

• High concordance observed between DTI-derived tracts and subcortical electrical mapping.
• DTI tractography demonstrates significant utility in guiding surgical interventions near critical white matter pathways.
• Limitations exist, stemming from both the DTI technique and tumor characteristics.

Conclusions:

• DTI tractography is a valuable non-invasive tool for presurgical planning in patients with brain tumors in eloquent regions.
• Awareness of DTI's inherent limitations is essential for its optimal application in the operating room.
• Further research may enhance the accuracy and reliability of DTI for surgical navigation.