Diffusion-tensor imaging (DTI) and tractography (DTT) in the surgical planning of brainstem cavernous malformations

Abstract

Background: Brainstem Cavernous Malformations (BSCMs) are vascular alterations that allow blood to pass into the central nervous tissue. When surgery is indicated, the preoperative use of DTI/DTT appears to improve prognosis. Objectives: Analyze the use of DTI/DTT in the surgical planning of BSCMs and their prognostic repercussions. Methods: An integrative review in which 25 articles in English from the last 14 years were found in the Pubmed database in April 2021, using the descriptors “brainstem”, “cavernous malformations” and “diffusion tensor imaging” and the boolean operator “And”. 4 articles from 2015 to 2021 were selected. Exclusion criteria: (1) Reviews; (2) Case reports; (3) Unrelated topic. Results: BSCMs commonly distort the region’s tracts, whose location and direction can be determined by DTI/DTT, offering a safer surgical planning. In a series with 10 BSCMs patients, in which 5 underwent preoperative DTI, 64% of the analyzed fibers presented some deformation, with 2 patients needing to have their surgical plan altered. A randomized clinical trial analyzed 23 BSCMs patients who underwent preoperative DTI/DTT and 24 conventionally evaluated, surgical morbidity and the percentage of patients with worsened motor deficits were lower in the DTI/DTT group (30,4% and 1,7%) than control (79,2% and 37,5%), indicating that such techniques may have better results. Conclusion: Preoperative DTI/DTT appears to be related to a better prognosis and surgical safety. However, further studies are needed to confirm its effectiveness in improving the prognosis of BSCMs patients.