FMRI-based Diffusion Tensor Tractography In The Operational Assessment Of Lesions Involving The Motor Areas In Patients

Neurosurgical treatment of gliomas involving the eloquent cortical areas has as its primarygoal the resecting of the maximum amount of tumor while still preserving the critical corticesand the fiber tract of the brain. DTT can visualize the major white matter tract if3D by settingROI on the path of the fibers on the basic of DTI. The purpose of our study was toprospectively evaluate whether preoperative fMRI-driven DTT could be used to show amaximal benefit for precise visualize of the spatial relationship between the eloquent areasand tumor. During surgery, the border of tumor was identified using neuronavigation andintraoperative ultrasonography for protecting deep white matter and enhancing the accuracyof resection.Objective To evaluate the value of incorporating fMRI into DTT in the operationalassessment of lesions involving the motor areas in patients. Methods Thirty patients withlesions involving the motor areas underwent3D T1-weighted imaging for anatomicalreference, a gradient echo planar imaging sequence for fMRI, and a spin echo-echo planarimaging sequence for DTI. We used two regions of interest (ROI) to define3D connectivitymaps within the whole brain, from seed points selected in the white matter adjacent to thelocation of the maximum of fMRI activation, and the target region of interest (ROI) wasplaced in the cerebral peduncle. During surgery, the border of tumor was identified usingneuronavigation and intraoperative ultrasonography for protecting deep white matter andenhancing the accuracy of resection. Results Total lesion resection was achieved intwenty-six patients, subtotal resection in four cases. In the thirty patients of all cases, wesuccessfully tracked the motor hand tracts by choosing seed and target regions of interest onpath of the fibers. What is more, no obvious harmful effects to the motor areas and adjacent fibers were observed in all patients. Conclusions fMRI-driven DTT can provide the ability toevaluate the spatial relationship between the motor tracts and tumor borders. Not only has thenew technology provided a maximum benefit in surgical treatment and improved preoperativeplan, but also enhanced the accuracy of postsurgical outcome.