Harnessing Advanced Tractography in Neurosurgical Practice

Abstract

This chapter explores the fundamentals and recent advancements of diffusion-weighted imaging (DWI) and its primary application, tractography. Both have become indispensable in the research arena and are currently being integrated into the clinical world, especially for neurosurgery. These technologies provide rapid, in vivo mapping of white matter tracts, greatly assisting surgeons in pre-surgical planning and enabling them to offer patients more precise prognostic information, thereby enhancing the process of informed decision-making. Despite nearly three decades of use in research and the development of sophisticated mapping techniques, the adoption of contemporary tractography methods in clinical settings has been slow. Here, we aim to provide a comprehensive understanding of DWI's basic principles, shed light on advanced methodologies that surpass the traditional diffusion tensor model, and discuss the clinical integration of tractography. Our objective is to advocate for the incorporation of newer tractography techniques into standard clinical practice.