• Haytham Elhawary, Haiying Liu, Pratik Patel, Isaiah Norton, Laura Rigolo, Xenophon Papademetris, Nobuhiko Hata, and Alexandra J Golby.
• Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, USA.
• Neurosurgery. 2011 Feb 1; 68 (2): 506516506-16; discussion 516.

BackgroundBrain surgery faces important challenges when trying to achieve maximum tumor resection while avoiding postoperative neurological deficits.ObjectiveFor surgeons to have optimal intraoperative information concerning white matter (WM) anatomy, we developed a platform that allows the intraoperative real-time querying of tractography data sets during frameless stereotactic neuronavigation.MethodsStructural magnetic resonance imaging, functional magnetic resonance imaging, and diffusion tensor imaging were performed on 5 patients before they underwent lesion resection using neuronavigation. During the procedure, the tracked surgical tool tip position was transferred from the navigation system to the 3-dimensional Slicer software package, which used this position to seed the WM tracts around the tool tip location, rendering a geometric visualization of these tracts on the preoperative images previously loaded onto the navigation system. The clinical feasibility of this approach was evaluated in 5 cases of lesion resection. In addition, system performance was evaluated by measuring the latency between surgical tool tracking and visualization of the seeded WM tracts.ResultsLesion resection was performed successfully in all 5 patients. The seeded WM tracts close to the lesion and other critical structures, as defined by the functional and structural images, were interactively visualized during the intervention to determine their spatial relationships relative to the lesion and critical cortical areas. Latency between tracking and visualization of tracts was less than a second for a fiducial radius size of 4 to 5 mm.ConclusionInteractive tractography can provide an intuitive way to inspect critical WM tracts in the vicinity of the surgical region, allowing the surgeon to have increased intraoperative WM information to execute the planned surgical resection.

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