The Value of Diffusion Tractography for Awake Surgery

Abstract AIMS Despite evidence of correspondence with intraoperative stimulation, there remains limited data on MRI diffusion tractography (DT)’s sensitivity to predict morbidity after brain tumour resection. Our aims were: (1) evaluate DT against subcortical stimulation mapping and performance changes during following awake surgery; (2) the use early post-operative recovery from post-surgical deficits. METHOD We performed a retrospective review our first 100 neurosurgery procedures using DTneuronavigation. Intra-operative outcomes were assessed classify predictions for specificity calculations. RESULTS Between 2014 2019 total 91 adult patients (mean age 49.2 years) underwent surgeries stimulation. The pre-operative 92.2% 69.2%, varying among tracts. Post-operative deficits occurred 41 (39%), but prolonged (>3 months) in only 4 (4%). was available 51 confirmed surgical preservation anticipated complete patient supplementary motor area syndrome, indicated infarct-related damage corticospinal fibers associated delayed, partial second patient. CONCLUSION Pre-operative provided very accurate spatial location tracts relation tumour. As expected, however, presence tract did not provide information its functional status, resulting variable individual While rare series, immediate period offered additional monitor neurological anticipate potential.