This study aims to analyze the benefits of the use of tractography in the preoperative and intraoperative scenarios.
We present a prospective cohort study with two groups of patients who underwent awake surgery for brain tumor resection: the control group for which no intraoperative navigated diffusion tensor imaging (DTI) was used (non-DTI group) and the case group (DTI group); surgical time, complete tumor resection, and neurological post-operative deficits were measured as primary outcomes. A secondary analysis was performed in order to determine the power of preoperative DTI to predict complete tumor resection.
Thirty-seven patients were included, 18 in the ‘non-DTI group’ and 19 in the ‘DTI group’. There were no differences between groups regarding sex, mean age, tumor histology and pre-operative mean tumor volume. The awake surgical time in the non-DTI group was 119.8 [SD 31.1] minutes and 93.6 [SD 12.2] minutes in the DTI-group (p=0.007). There was a trend toward complete tumor resection in the ‘DTI group’ (p=0.09). Sensitivity and specificity for predicting complete tumor resection were 88% and 62.5% for the non-DTI group, compared with 100% and 80%, respectively, for the DTI group. The ROC area was 0.720 in the non-DTI group vs 0.966 in the DTI group (p=0.041).
Intraoperative navigated tractography helps shorten the time of awake neuro-oncological surgery as well as might offer a trend toward complete tumor resection. Tractography used in the preoperative planning could be an useful tool for better predicting complete tumor resection.

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