Assessment of MR-Tractography During Resection of Intra-Axial Cerebral Lesions

Object: Fiber tracking of the major white tracts is not only a method for preoperative neurosurgical visualization but also is useful for further intra-operative planning.Methods: A prospective study of a total of 25 patients with intracerebral lesions with a mean follow-up of 1.2 months (range 1 week – 3 months). All patients had complete neuro-clinical assessments for assessment of preoperative neurological deficit. Patients were also assessed postoperatively for newly developed deficits and for following improvement or deterioration of the preop ones. We had also neuro-radiographic assessment complete MRI study. FOR DTI, spin-echo diffusion weighted echo-planer imaging. DTI color fractional anisotropy (FA) maps were done, and white matter tracts adjacent to the tumor were reconstructed. The data of the fiber tracts are imported into the navigation system.Results: At 1-month follow-up; one previously asymptomatic patient reported a speech disorder (transcortical sensory dysphasia). In the remaining 24 patients, symptoms remained unchanged, with a tendency to improvement in 14/17 with symptoms related to involvement of white matter tracts studied. The degree of tract shifting was measured by –10 to +22 (average 9.6±2.1).Conclusion: Magnetic resonance Tractography can change the old outcome of intraxial brain tumour surgeries and offers both preoperative and intraoperative plan for safe surgery.