title: Intraoperative use of diffusion tensor imaging fiber tractography and subcortical mapping for resection of gliomas: technical considerations.
abstract: Resection of lesions involving motor or language areas or pathways requires the intraoperative identification of functional cortical and subcortical sites for effectively and safe guidance. Diffusion tensor (DT) imaging and fiber tractography are MR imaging techniques based on the concept of anisotropic water diffusion in myelinated fibers, which enable 3D reconstruction and visualization of white matter tracts and provide information about the relationship of these tracts to the tumor mass. The authors routinely used DT imaging fiber tractography to reconstruct various tracts involved in the motor and/or language system in a large series of patients with lesions involving the motor and/or language areas or pathways. The DT imaging fiber tractography data were loaded into the neuronavigational system and combined intraoperatively with those obtained from direct electrical stimulation applied at the subcortical level. In this paper the authors report the results of their experience, describing the findings for each tract and discussing technical aspects of the combined use as well as the pitfalls.
authors.affiliation: Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Milano, 20122 Milan, Italy. lorenzo.bello@unimi.it
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bello
authors.forename: Antonella
authors.initials: A
authors.lastname: Castellano
authors.forename: Enrica
authors.initials: E
authors.lastname: Fava
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Casaceli
authors.forename: Marco
authors.initials: M
authors.lastname: Riva
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scotti
authors.forename: Sergio Maria
authors.initials: SM
authors.lastname: Gaini
authors.forename: Andrea
authors.initials: A
authors.lastname: Falini
mesh_terms: D016880:Anisotropy; D001921:Brain / Q000473:pathology / Q000502:physiology* / Q000601:surgery*; D001931:Brain Mapping / Q000379:methods*; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002540:Cerebral Cortex / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery; D056324:Diffusion Tensor Imaging / Q000379:methods*; D004525:Efferent Pathways / Q000033:anatomy & histology / Q000502:physiology; D004569:Electroencephalography / Q000706:statistics & numerical data; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007802:Language; D007807:Language Tests; D008279:Magnetic Resonance Imaging / Q000379:methods; D009044:Motor Cortex / Q000033:anatomy & histology / Q000502:physiology; D038361:Neuronavigation / Q000379:methods; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000379:methods*