White Matter Reorganization After Surgical Resection of Brain Tumors and Vascular Malformations

• Published in: American Journal of Neuroradiology Vol. 27; no. 6; pp. 1258 - 1271
• Main Authors: Lazar, M, Alexander, A.L, Thottakara, P.J, Badie, B, Field, A.S
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.06.2006; American Society of Neuroradiology
• Subjects: Adolescent; Adult; Biological and medical sciences; Brain; Brain - pathology; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Child; Child, Preschool; Diffusion Magnetic Resonance Imaging; Electrodiagnosis. Electric activity recording; Fundamental and applied biological sciences. Psychology; Humans; Image Processing, Computer-Assisted; Intracranial Arteriovenous Malformations - pathology; Intracranial Arteriovenous Malformations - surgery; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Middle Aged; Nervous system; Personality. Affectivity; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Pyramidal Tracts - pathology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sexuality. Sexual behavior; Nervous system diseases; Radiodiagnosis; Malformation; Central nervous system; Surgical resection; Tumor; White matter; Encephalon
• ISSN: 0195-6108; 1936-959X; 1432-1920

Diffusion tensor imaging (DTI) and white matter tractography (WMT) are promising techniques for estimating the course, extent, and connectivity patterns of the white matter (WM) structures in the human brain. In this study, DTI and WMT were used to evaluate WM tract reorganization after the surgical resection of brain tumors and vascular malformations. Pre- and postoperative DTI data were obtained in 6 patients undergoing surgical resection of brain lesions. WMT using a tensor deflection algorithm was used to reconstruct WM tracts adjacent to the lesions. Reconstructed tracts included corticospinal tracts, the corona radiata, superior longitudinal and inferior fronto-occipital fasciculi, cingulum bundles, and the corpus callosum. WMT revealed a series of tract alteration patterns including deviation, deformation, infiltration, and apparent tract interruption. In general, the organization of WM tracts appeared more similar to normal anatomy after resection, with either disappearance or reduction of the deviation, deformation, or infiltration present preoperatively. In patients whose lesions were associated with corticospinal tract involvement, the WMT reconstructions showed that the tract was preserved during surgery and improved in position and appearance, and this finding correlated with improvement or preservation of motor function as determined by clinical assessment. WMT is useful for appreciating the complex relationships between specific WM structures and the anatomic distortions created by brain lesions. Further studies with intraoperative correlation are necessary to confirm these initial findings and to determine WMT utility for presurgical planning and evaluation of surgical treatments.