Diffusion tensor tractography in patients with cerebral tumors: a helpful technique for neurosurgical planning and postoperative assessment.

OBJECTIVE: To demonstrate the role of diffusion tensor tractography (DTT) in preoperative mapping of eloquent tracts in relation to cerebral tumors and to determine whether it is helpful for neurosurgical planning and postoperative assessment. METHODS AND MATERIALS: Sixteen patients with brain tumors underwent diffusion tensor imaging (DTI). The pyramidal tract, corpus callosum and optic radiation were reconstructed and the exact location of a lesion with respect to these tracts was observed to design a reasonable surgical plan for preserving vital tracts while maximizing tumor resection. After surgery, DTI was performed again and these tracts were evaluated to investigate the surgical outcomes. Twenty-four patients with suspicion of pyramidal tract involvement were also evaluated as a control group.
RESULTS: The relationship between tracts and tumors was classified as three types: type I is simple displacement, type II is displacement with disruption and type III is simple disruption. Twelve cases involved in pyramidal tract (DTT group), one was type I with reduction of displacement after surgery, nine were type II with reduction of displacement and other two were type III without any improvement. The extent of tumor resection (p = 0.045) and postoperative improvement of locomotive function (p = 0.015) of DTT group were significantly higher than those of control group. Corpus callosum was involved in seven cases, three were type II with reduction of displacement and four were type III without any improvement. Optic radiation was involved in three cases, all were type I with reduction of displacement.
CONCLUSION: DTT allowed for visualization of the exact location of tumors relevant to eloquent tracts and was found to be beneficial in the neurosurgical planning and postoperative assessment.