Role of Diffusion Tensor Imaging in Brain Tumor Surgery

Area of Science:

• Neurosurgery
• Neuroradiology
• Medical Imaging

Background:

• Intra-axial brain tumors (gliomas and metastasis) pose surgical challenges due to proximity to critical white matter (WM) tracts.
• Accurate preoperative assessment of WM tract integrity is crucial for surgical planning to minimize postoperative neurological deficits.

Purpose of the Study:

• To evaluate the role of diffusion tensor imaging (DTI) in assessing white matter (WM) tracts in patients with intra-axial brain tumors.
• To utilize DTI for preoperative surgical planning to optimize surgical corridors and reduce neurological deficits.

Main Methods:

• 34 patients with intra-axial brain tumors underwent pre-operative contrast-enhanced MRI and DTI scans.
• Neurological examinations were performed pre- and post-operatively to assess outcomes.
• Surgical corridors and extent of resection were planned based on DTI findings.

Main Results:

• DTI identified WM tract involvement, including displacement (61.7%), invasion (32.3%), and disruption (11.7%).
• Total tumor resection was more successful in cases with only displaced tracts (61.1%) compared to invaded/disrupted tracts (31.2%).
• Postoperative deficits included motor power (11.7%), language (8.82%), and memory (2.94%).

Conclusions:

• DTI is a valuable tool for preoperative surgical planning in intra-axial brain tumors.
• It provides critical information on WM tract infiltration and displacement.
• WM tract involvement is a significant predictor of surgical outcomes.