The Use of Diffusion Tensor Images of the Corticospinal Tract in Intrinsic Brain Tumor Surgery: A Comparison With Direct Subcortical Stimulation

BACKGROUND: Diffusion tensor imaging (DTI) is now widely used in neurosurgery to preoperatively delineate the course of the pyramidal tract. OBJECTIVE: To evaluate the accuracy of the method by comparison with subcortical electrical stimulation and to evaluate the influence of the distance of the pyramidal tract from the tumor on the resection extent and postoperative clinical deficits. METHODS: A diffusion tensor imaging depiction of the pyramidal tract was used in preoperative planning and intraoperative navigation in 72 cases. In 36 cases, subcortical electrical stimulation was used during the resection. The preoperative tumor-to-tract distance was compared with the stimulation result, the extent of resection, and the short-term postoperative course. RESULTS: A significant nonlinear relationship between the tract-to-tumor distance and the probability of a motor response to subcortical stimulation was observed. The largest preoperatively measured tumor-to-tract distance with a positive stimulation result was 8 mm. Moreover, we observed a trend toward transient postoperative motor deterioration in patients with tumors close to the pyramidal tract. Resection extent was not significantly affected by the tumor-to-tract distance. CONCLUSION: Despite methodological obstacles, reasonable accuracy of the diffusion tensor imaging reconstructions of the pyramidal tracts was confirmed by our study. The occurrence of transient postoperative motor deterioration is higher in patients with tumors located close to the pyramidal tract.