Romanian Neurosurgery (Dec 2011)
The role of MR tractography in pre-surgical planning
Abstract
Diffusion tensor imaging (DTI) contains a wealth of information on molecular diffusion in biological tissues [1,2]. Visualizing the white-matter tracts using diffusion anisotropy maps represents one of the applications with a major impact on neurosurgical case management [3]. Knowledge of the topography, integrity, and involvement by the pathological process of the white matter tracts is an important factor in pre-surgical planning for patients with brain lesions. We have evaluated the clinical utility of a magnetic resonance tractography technique based on DTI. We studied, in a prospective manner, 25 cases with lesions involving salient intracerebral and medullary tumors (22 and 3 cases respectively). All cases followed a preoperative imaging protocol that included DTI on top of the usual MR imaging protocol. We analyzed the DTI findings preoperatively and looked at the significant information that influences the surgical plan: position of the significant white matter tracts, the degree of their involvement in the pathological process and anatomical integrity, relationships with important anatomical landmarks and with the major surgical approach paths. We present the postoperative results and some of the most illustrative cases in the series and compare our results with the similar studies in the literature. Our experience, based on the results of the present study strongly suggests that in depth knowledge of the white matter tracts involvement in an intracerebral or intramedullary pathological process improves significantly the surgical planning in terms of surgical procedure safety and functional outcome.
