Application of magnetic resonance tractography in the perioperative planning of patients with eloquent region intra-axial brain lesions.

We aimed to assess the role of preoperative diffusion tensor tractography (DTT) in the surgical planning and prognostication of the postoperative outcome of patients with lesions in the eloquent areas of the brain. From 2006 to 2009, 50 patients were preoperatively evaluated with DTT and image-guidance studies. Three-dimensional (3D) color trajectory maps of white-matter tracts adjacent to the lesions were reconstructed. The usefulness of tractography in perioperative planning was graded on a scale of 1 to 4. The postoperative outcomes were studied in relation to the pattern of tract involvement. The lesions included brain tumors in 40 patients, vascular malformations in five patients and other lesions in five patients. An awake craniotomy was performed in 19 patients. The tracts were only displaced in 72% of patients, completely infiltrated in 14% and had a combined pattern in 14%. DTT significantly altered the planning (score ≥ 3) in 62% of patients. Patients with pure displacement had the best outcome, while those with infiltration had a poorer outcome. We conclude that tractography improves surgical safety and aids prognostication in surgery of patients with eloquent cortex lesions.