Progressive axonal degeneration in white matter pathways traversing peritumoral penumbra in frontotemporal glioma

Optimal treatment of glioma has been a subject of debate over the last few decades, since maximal resection can improve survival, whereas preservation of functional peritumoral brain tissue minimizes the risk of postoperative neurological deficits. Our preliminary study uses tractography and neural tissue microstructure modeling based on diffusion MRI to quantify progressive axonal degeneration in proximity to frontotemporal glioma. For this, we sample major white matter pathways that traverse peritumoral penumbra at two time points. The results show a pattern of decreased intra-axonal water fraction beyond anatomical MRI abnormalities, which may indicate a tumor invasion of normal-appearing white matter that potentially advocates supratotal resection.