Tractography and the connectome in neurosurgical treatment of gliomas: the premise, the progress, and the potential

Abstract

<jats:p>The ability of diffusion tensor MRI to detect the preferential diffusion of water in cerebral white matter tracts enables neurosurgeons to noninvasively visualize the relationship of lesions to functional neural pathways. Although viewed as a research tool in its infancy, diffusion tractography has evolved into a neurosurgical tool with applications in glioma surgery that are enhanced by evolutions in crossing fiber visualization, edema correction, and automated tract identification. In this paper the current literature supporting the use of tractography in brain tumor surgery is summarized, highlighting important clinical studies on the application of diffusion tensor imaging (DTI) for preoperative planning of glioma resection, and risk assessment to analyze postoperative outcomes. The key methods of tractography in current practice and crucial white matter fiber bundles are summarized. After a review of the physical basis of DTI and post-DTI tractography, the authors discuss the methodologies with which to adapt DT image processing for surgical planning, as well as the potential of connectomic imaging to facilitate a network approach to oncofunctional optimization in glioma surgery.</jats:p>

From Neurosurgical Planning to Histopathological Brain Tumor Characterization: Potentialities of Arcuate Fasciculus Along-Tract Diffusion Tensor Imaging Tractography Measures

“…Many technical limitations such as the inability of deterministic tractography to resolve kissing and crossing fibers have been overcome by the use of high angular resolution diffusion imaging (HARDI) acquisitions and innovative highorder crossing fiber models, such as constrained spherical deconvolution (9). Tractography can currently provide an accurate visualization of the spatial relationship between the intra-axial tumors, such as gliomas, and the subcortical tracts, contributing to more precise surgical planning and to guiding tumor resection intraoperatively (2)(3)(4)(5)(6)(7)(8).…”

Supratentorial high-grade gliomas: maximal safe anatomical resection guided by augmented reality high-definition fiber tractography and fluorescein

“…Diffusion tensor imaging (DTI) high-definition fiber tractography (HDFT) has been proven useful for planning of the brain tumor resection as well as the postoperative assessment of the residual structural anatomical connectivity of the white matter fiber tracts. [5][6][7] However, the potential benefits of its intraoperative use have not been extensively studied, with the exception of an experimental level often involving virtual or mixed reality. Contrary to augmented reality (AR), which has recently gained an increasing interest due to its extraordinary feasibility, virtual and mixed realities still have a wide range of limitations related to their implementation in the operative scenario.…”

Track-Density Ratio Mapping With Fiber Types in the Cerebral Cortex Using Diffusion-Weighted MRI

“…The asymmetry in the fiber structure between the left and right hemispheres suggests the functional laterality in the corresponding area. Finally, this technique has the potential for diagnosing brain diseases by characterizing the anatomical distinction of the fiber amount and fiber type between populations in the cerebral cortex (Nir et al, 2015 ; Henderson et al, 2020 ). The TDRM hopes to be used as an alternative biomarker to diagnose neurodegenerative diseases (Prasad et al, 2013 ; Nir et al, 2015 ) or tumor (Stadlbauer et al, 2010 ; Henderson et al, 2020 ) in the brain associated with abnormalities in the distribution characteristics of that.…”