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Intraoperative Reconstructed Fiber Tractography: Feasibility and Preliminary Results
Iulia Peciu-Florianu1, Quentin Vannod-Michel2, Benoit Derre1
1Neurosurgery Department, CHU-Lille, Lille, France.
World Neurosurgery
|June 16, 2026
Summary
Intraoperative fiber tractography (iFT) using diffusion tensor imaging (DTI) is feasible for brain surgery, aiding in preserving neurological function. However, air artifacts significantly impact its accuracy during surgery.
Area of Science:
- Neurosurgery
- Medical Imaging
- Neuroscience
Background:
- Awake surgery and intraoperative MRI (iMRI) enhance resection extent and neurological function preservation.
- Diffusion tensor imaging (DTI) reconstructs subcortical white matter bundles, assessing their integrity.
Purpose of the Study:
- To evaluate the feasibility of intraoperative fiber tractography (iFT).
- To identify factors influencing iFT quality.
- To assess the clinical value of iFT in neurosurgery.
Main Methods:
- A two-phase study (retrospective and prospective) involving patients undergoing iMRI-guided surgery.
- Inclusion criteria: age >18, intraparenchymal pathology, preoperative and intraoperative DTI availability.
- Resections performed during awake surgery with systematic iFT protocol and analysis of tract reconstruction factors.
Main Results:
- Analyzed 59 DTI sequences from 24 patients with various brain pathologies.
- Intraoperative DTI was interpretable in 83% and iFT reconstructed in 79% of cases.
- Air presence was the main limiting factor for iFT accuracy, correlating with artifacts.
Conclusions:
- Intraoperative fiber tractography is feasible and clinically valuable in neurosurgery.
- Accuracy of iFT is significantly affected by air-related artifacts.
- Further research is needed to mitigate artifact impact on iFT quality.
