Prof. Domenico Chirchiglia MD
In brain tumor surgery the aim is to excise the tumor without creating superior function deficits, so
try to spare the so-called eloquent areas. Since the early twentieth century, neurosurgeons like Penfield have
paid attention to the preservation of the language areas as well as of the motor pathways during brain surgery.
Cortical electrical stimulation and brain mapping were used with good results. The problem was for a long time
the invasiveness of the surgery which however foresaw a craniotomy. A few years ago a new and revolutionary
technique has established itself. The diffusion tensor Imaging (DTI) is a non-invasive method that includes the
use of MRI, allowing the study of white matter and therefore of the cortico-spinal tracts. Tractography is able
to distinguish normal nerve fibers from those infiltrated by the tumor, detecting pathological features of white
matter such as axonal damage, ischemia, inflammation, edema. The literature is rich in cases related to the use
of DTI in brain tumors, the results are excellent if if one thinks of the saving of functionally important brain
areas. Therefore, the excision of malignant tumors such as gliomas and glioblastomas is followed by a different
and better outcome and a different quality of life. DTI Tractography today represents the best and safest way of
preserving the superior cortical functions in brain tumour surgery
