Introduction: White matter cerebral tracts may be displaced, invaded or destroyed by intrinsic or extrinsic tumor growth. Postoperative neurological deficits may arise de novo or worsen if previously uninvolved tracts are injured. MRI tractography is a novel technique applied to visualize the distribution of the nearby tracts. The condition and the location of the tract may determine the radicalism of surgical strategy and the trajectory of surgery.
The authors evaluated the value of tractography in preoperative decision making during surgery of brain lesions
Methods: MRI tractography was performed in 30 patients with intrinsic brain lesions. The condition and the location of the tracts, and their influence on surgical decision were studied. Two surgeons have separately decided on the best approach for surgery of brain tumors with and without availability of tractography data. Changing the decision was recorded and correlated to the tractography data
Results: MRI tractography was a highly influencing study in decision making before embarking on surgery for deep brain lesions related to important recordable brain tracts. Decisions for the proposed trajectory corridor and resection radicallity changed significantly when tractography data became available
Conclusions: MRI tractography helps in determining the site of the cortical incision and the trajectory corridor to access superficial or deeply seated brain lesions. In the same time, it has significant impact on the decision between radicalism and conservatism in many cases
Patient Care: By the conclusion of this session , participants will be able to:1. Describe the importance of MRI tractography in brain surgery
2. Discuss in small groups the value of MRI tractography on performing safe neurosurgery
3. Modify surgical corridor according to available MRI tractography data
Learning Objectives: The attendees will be able modifying the surgical trajectory after reviewing MRI tractography data in deep or superficial brain lesions to achieve safer surgical results