Vergani Fracesco, Sarubbo Silvio, Yang Joseph Yuan-Mou
Neurosurgical Department, King's College Hospital, London, UK.
Department of Neurosurgery, S. Chiara University-Hospital, Azienda Provinciale per I Servizi Sanitari, Trento, 39122, Italy.
Brain Struct Funct. 2025 Jun 3;230(5):81. doi: 10.1007/s00429-025-02948-y.
The integration of diffusion MRI tractography into neurosurgical practice raises an essential question: is this technology accurate enough to be used to inform surgery? This short communication summarizes the key points of a debate held at the 2024 Tract-Anat Retreat on the clinical utility and limitations of tractography in neurosurgery. While tractography in neurosurgery offers unique insights into patient-specific white matter anatomy and has proven value for surgical planning, risk stratification and patient counselling, we identified limitations, challenges, and areas for improvement. These include variability in reconstruction methods, the importance of multimodal integration, false negative results and intrinsic limitations at surgery, such as brain shift during navigation. These perspectives highlight the need for standardized protocols, functional validation, and enhanced surgeon training to ensure the cautious and effective use of tractography in the operative setting.
这项技术是否足够精确，可用于指导手术？本简短通讯总结了在2024年纤维束-解剖学研讨会上就神经外科中纤维束成像的临床应用和局限性展开的辩论要点。虽然神经外科中的纤维束成像为特定患者的白质解剖结构提供了独特见解，并已证明在手术规划、风险分层和患者咨询方面具有价值，但我们也发现了其局限性、挑战及有待改进之处。这些包括重建方法的变异性、多模态整合的重要性、假阴性结果以及手术中的内在局限性，如导航过程中的脑移位。这些观点强调了需要标准化方案、功能验证以及加强外科医生培训，以确保在手术环境中谨慎且有效地使用纤维束成像技术。
