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Updated: Jun 18, 2026
Fiber Connections of the Supplementary Motor Area Revisited: Methodology of Fiber Dissection, DTI, and Three Dimensional Documentation
Published on: May 23, 2017
Intraoperative Reconstructed Fiber Tractography: Feasibility and Preliminary Results
Iulia Peciu-Florianu1, Quentin Vannod-Michel2, Benoit Derre1
1Neurosurgery Department, CHU-Lille, Lille, France.
Background:
Awake surgery and intraoperative magnetic resonance imaging optimize the extent of resection while preserving neurological function. Diffusion tensor imaging (DTI) enables reconstruction of subcortical white matter bundles, allowing assessment of compression, partial invasion, or destruction.
Primary Endpoint:
evaluate the feasibility of intraoperative fiber tractography (iFT); secondary endpoints: identify factors influencing tractography quality and assess its clinical value.
Methods:
A two-phase study was conducted. A retrospective phase: all patients undergoing intraoperative magnetic resonance imaging-guided surgery at the Neurosurgery Department of Lille University Hospital between 2014 and 2021 were screened. Inclusion criteria included age >18 years, intraparenchymal pathology requiring resection, and availability of both preoperative and intraoperative DTI. In this proof-of-concept cohort, resections were systematically performed during awake surgery allowing clinical correlation. Prospective validation phase (November 2021-September 2022): resections were guided using the established intraoperative tractography protocol. Subcortical bundles of interest were identified, and qualitative and quantitative factors affecting tract reconstruction were analyzed.
Results:
Fifty-nine DTI sequences from 24 patients (mean age 41 years; range 22-66) were analyzed, including drug-resistant epilepsy, low- and high-grade gliomas, and metastases. Evaluated bundles were: arcuate fasciculus, inferior fronto-occipital fasciculus, corticospinal tract, and optic radiations. Awake surgery was performed in 75% of cases. Intraoperative DTI was interpretable in 83%, and iFT was reconstructed in 79%. Air presence was the main limiting factor, correlating with blood artifacts, ischemic changes, and saline filling of the resection cavity. Intraoperative FT correlated with color map visualization and preoperative tract reconstruction.
Conclusion:
iFT is feasible and clinically valuable, although its accuracy is significantly affected by air-related artifacts.
