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Related Experiment Video

Updated: Oct 31, 2025

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Published on: July 5, 2021

Diffusion tractography for awake craniotomy: accuracy and factors affecting specificity.

Natalie L Voets¹, Pieter Pretorius², Martin D Birch³

¹Department of Neurosurgery, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, West Wing, L3, Oxford, Oxfordshire, OX3 9DU, UK.

Journal of Neuro-Oncology

|July 1, 2021

Summary

Diffusion tractography (DT) accurately maps white matter tracts for brain tumor surgery. Early post-operative DT can help predict patient recovery from neurological deficits after surgery.

Keywords:

Awake surgery DTI Diffusion tractography Glioma Stimulation

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Last Updated: Oct 31, 2025

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Published on: July 5, 2021

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Area of Science:

Neurosurgery
Neuroimaging
Oncology

Background:

Limited data exists on MRI diffusion tractography (DT) sensitivity for predicting morbidity after neurosurgical oncology treatment.
Intraoperative stimulation provides some correspondence, but DT's predictive value needs further evaluation.

Purpose of the Study:

To evaluate DT against subcortical stimulation mapping and performance changes during and after awake neurosurgery.
To assess the utility of early post-operative DT in predicting recovery from post-surgical deficits.

Main Methods:

Retrospective review of 100 awake neurosurgery procedures using DT-neuronavigation.
Intraoperative stimulation and performance outcomes assessed for DT prediction accuracy (sensitivity, specificity).
Post-operative DT data (51 patients) inspected for tract damage and correlation with recovery.

Main Results:

Pre-operative DT showed high sensitivity (92.2%) but variable specificity (69.2%) in predicting tract location.
Post-operative deficits occurred in 39% of procedures, with prolonged deficits rare (4%).
Post-operative DT confirmed tract preservation and aided in predicting recovery in specific cases.

Conclusions:

Pre-operative DT accurately predicts tract spatial location but not functional status, leading to variable specificity.
While prolonged deficits are uncommon, post-operative DT shows potential for monitoring neurological deficits and anticipating recovery.
DT is a valuable tool in neurosurgical oncology, especially when combined with intraoperative monitoring.