• Alessandro Bozzao, Andrea Romano, Albina Angelini, Giancarlo D'Andrea, Luigi Fausto Calabria, Valeria Coppola, Luciano Mastronardi, Luigi Maria Fantozzi, and Luigi Ferrante.
• Department of Neuroradiology, University of Rome Sapienza, Ospedale Sant'Andrea, Via di Grottarossa 1034, 00189, Rome, Italy. alessandro.bozzao@uniroma1.it
• Eur Radiol. 2010 Oct 1;20(10):2475-81.

ObjectiveTo demonstrate the accuracy of magnetic resonance tractograpghy (MRT) in localizing the cortical spinal tract (CST) close to brain tumours by using intraoperative electric subcortical stimulation.MethodsNine patients with intra-axial brain tumours underwent neurosurgery. Planning was based on analysis of the course of streamlines compatible with the CST. After tumour removal, intraoperative MRT was reacquired. Sites at various distance from the CST were repeatedly stimulated to assess whether registered motor evoked potential (MEP) could be elicited. All patients were assessed clinically both pre- and postoperatively.ResultsThe motor function was preserved in all patients. In all patients intraoperative MRT demonstrated shift of the bundle position caused by the surgical procedure. The distance between the estimated intraoperative CST and the point of elicited MEP was 1 cm or less in all nine patients. At distances greater than 2 cm, no patient reported positive MEP.ConclusionIntraoperative MRT is a reliable technique for localization of CST. In all patients MEP were elicited by direct subcortical electrical stimulation at a distance below 1 cm from the CST as represented by MRT. Brain shifting might impact this evaluation since CST position may change during surgery in the range of 8 mm.

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