• Tsukasa Koike, Shota Tanaka, Taichi Kin, Yuichi Suzuki, Shunsaku Takayanagi, Hirokazu Takami, Kazuha Kugasawa, Shohei Nambu, Takaki Omura, Erika Yamazawa, Yoshihiro Kushihara, Yasuyuki Furuta, Ryoko Niwa, Katsuya Sato, Tatsuya Uchida, Yasuhiro Takeda, Satoshi Kiyofuji, Toki Saito, Hiroshi Oyama, and Nobuhito Saito.
• Department of Neurosurgery, University of Tokyo, Tokyo, Japan.
• World Neurosurg. 2022 Aug 1; 164: e764-e771.

BackgroundTractography is one way to predict the distribution of cortical functional domains preoperatively. Diffusion tensor tractography (DTT) is commonly used in clinical practice, but is known to have limitations in delineating crossed fibers, which can be overcome by Q-ball imaging tractography (QBT). We aimed to compare the reliability of these 2 methods based on the spatial correlation between the arcuate fasciculus depicted by tractography and direct cortical stimulation during awake surgery.MethodsIn this study, 15 patients with glioma underwent awake surgery with direct cortical stimulation. Tractography was depicted in a three-dimensional computer graphic model preoperatively, which was integrated with a photograph of the actual brain cortex using our novel mixed-reality technology. The termination of the arcuate fasciculus depicted by either DTT or QBT and the results of direct cortical stimulation were compared, and sensitivity and specificity were calculated in speech-associated brain gyri: pars triangularis, pars opercularis, ventral precentral gyrus, and middle frontal gyrus.ResultsQBT had significantly better sensitivity and lower false-positive rate than DTT in the pars opercularis. The same trend was noted for the other gyri.ConclusionsQBT is more reliable than DTT in identification of the motor speech area and may be clinically useful in brain tumor surgery.Copyright © 2022 Elsevier Inc. All rights reserved.

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