Intraoperative Use and Benefits of Tractography in Awake Surgery Patients

The present study analyzed the benefits of the use of tractography in the preoperative and intraoperative scenarios.

We present a prospective cohort study with 2 groups of patients who had undergone awake surgery for brain tumor resection. A control group for which no intraoperative navigated diffusion tensor imaging (DTI) was used (non-DTI group) and the case group (DTI group). The operative time, complete tumor resection, and neurological postoperative deficits were measured as primary outcomes. A secondary analysis was performed to determine the power of preoperative DTI to predict for complete tumor resection.

A total of 37 patients were included, 18 in the non-DTI group and 19 in the DTI group. No differences were found between the 2 groups for sex, mean age, tumor histological findings, and preoperative mean tumor volume. The awake surgical time in the non-DTI group was 119.8 ± 31.1 minutes and 93.6 ± 12.2 minutes in the DTI group (P = 0.007). A trend was found toward complete tumor resection in the DTI group (P = 0.09). The sensitivity and specificity for predicting complete tumor resection were 88% and 62.5% for the non-DTI group and 100% and 80% for the DTI group, respectively. The area under the receiver operating characteristic curve was 0.720 in the non-DTI group and 0.966 in the DTI group (P = 0.041).

Intraoperative navigated tractography shortened the time of awake neuro-oncological surgery and might provide help in performing complete tumor resection. Also, tractography used in the preoperative planning could be a useful tool for better prediction of complete tumor resection.