Introduction: Advanced neuroimaging tools are essential for preoperative planning for maximizing tumor resection and preserving brain function. Diffusion Tensor Imaging (DTI) with tractography has emerged as a valuable tool in neurosurgical practice, providing insights into the relationship between white matter tracts and intracranial lesions, hence aiding in preoperative planning. Our aim was to investigate the impact of DTI on preoperative planning and surgical outcomes.

Methods: A retrospective analysis was conducted in 22 patients who underwent neurosurgical procedures where DTI was utilized for preoperative planning. DTI examinations were performed with a 3T magnet (Siemens Verio), while postprocessing was carried out with Syngo.via (VB60A), a CE-marked software capable of computing white matter tracts with deterministic tractography. The DTI data were postprocessed to visualize major white matter tracts, such as the corticospinal tract (CST) and the arcuate fasciculus (AF) close to the lesions, which included 21 intraaxial tumours of various histological types and 1 cavernoma. The relationship between the tracts and the lesions was categorised into three groups: intact, dislocated or infiltrated tract. Comparison of the preand postoperative clinical status was used to determine the benefit of the DTI mesurement.

Results: Surgical plans were adjusted to the DTI findings. In 6 cases, the CST was intact according to the tractography and total lesion resection was performed with good clinical outcome. In 9 cases, the tracts were dislocated and in 2 cases, the tracts were infiltrated by the lesions, making the neurosurgeon perform only partial resection to preserve function.

Conclusion: DTI facilitated precise delineation of the white matter tracts in relation to the lesions, aiding in selecting the best surgical approach and defining the extent of safe resection. Therefore, DTI serves as a valuable adjunct to conventional neuroimaging modalities and may have a significant impact on improving surgical outcomes.