Preoperative MR Tractography For Functional Risk Assessment in Pediatric Subcortical Supratentorial Tumors

Arzu R. Akhmedova; Otabek V. Ablyazov

doi:10.37547/ijmsphr/Volume07Issue05-16

Authors

Arzu R. Akhmedova

National Children’s Medical Center, Department of Radiology, Uzbekistan
Otabek V. Ablyazov

Center for Professional Development of Medical Workers, Department of Medical Radiology; Central Military Hospital, Uzbekistan

Keywords

Pediatric brain tumors subcortical supratentorial tumors magnetic resonance imaging

Abstract

Pediatric subcortical supratentorial tumors represent a complex group of intracerebral neoplasms characterized by heterogeneous clinical presentation and variable relationships with functionally significant white matter pathways. Conventional magnetic resonance imaging provides important anatomical information; however, its ability to assess the functional-topographic organization of subcortical white matter remains limited. To evaluate the clinical and radiological features of pediatric subcortical supratentorial tumors and to determine the diagnostic value of MR tractography in assessing tumor relationships with functionally significant white matter pathways during preoperative planning. This retrospective study included 100 pediatric patients with subcortical supratentorial tumors who underwent standard magnetic resonance imaging and diffusion tensor MR tractography before surgical treatment. Clinical presentation, conventional MRI characteristics, tractographic patterns of tumor-white matter interaction, intraoperative findings, and postoperative neurological outcomes were analyzed comparatively. A control group of 20 neurologically healthy pediatric subjects was additionally evaluated to characterize normal tractographic anatomy. Conventional MRI demonstrated considerable variability in tumor morphology, contour characteristics, perifocal edema, and mass effect across different subcortical localizations, limiting the reliability of standard anatomical assessment. MR tractography revealed a broad spectrum of tumor–tract relationships, including tract displacement, deformation, thinning, and partial involvement. Moderate tract displacement represented the most frequent tractographic pattern. More severe tractographic abnormalities were associated with a progressively higher incidence of persistent postoperative neurological deficits. Tractographic findings demonstrated high concordance with intraoperative observations, confirming the clinical relevance of preoperative tractographic assessment. MR tractography provides clinically significant functional-topographic information that cannot be reliably obtained using conventional MRI alone. Integration of tractographic analysis into preoperative evaluation may improve surgical planning and facilitate more accurate assessment of functional risk in children with subcortical supratentorial tumors.

Downloads

Download data is not yet available.

References

1

Acta Neurochirurgica Foley R., Boop F. Tractography guides the approach for resection of thalamopeduncular tumors // Acta Neurochirurgica. 2017. Vol. 159, No. 9. P. 1597-1601.

2

Brain Structure and Function Vergani F., Sarubbo S., Yang J.Y. Debate: is tractography accurate enough to be used to inform surgery? // Brain Structure and Function. 2025. Vol. 230, No. 5. Art. 81.

3

Neuro-Oncology Hu J., Bao H., Liu X. et al. Glioma-white matter tract interactions: a diffusion magnetic resonance imaging-based 3-tier classification and its clinical relevance // Neuro-Oncology. 2025. Vol. 27, No. 7. P. 1888-1898.

4

Journal of Neurosurgery Zhang W., Ille S., Schwendner M. et al. Tracking motor and language eloquent white matter pathways with intraoperative fiber tracking versus preoperative tractography adjusted by intraoperative MRI-based elastic fusion // Journal of Neurosurgery. 2022. Vol. 137, No. 4. P. 1114-1123.

5

Neurosurgical Focus Xiao X., Kong L., Pan C. et al. The role of diffusion tensor imaging and tractography in the surgical management of brainstem gliomas // Neurosurgical Focus. 2021. Vol. 50, No. 1. Art. E10.

6

Brain Structure and Function Chong S.T., Yang J.Y., Lin C.P. Understanding tractography in edematous brain regions: challenges and solutions // Brain Structure and Function. 2025. Vol. 230, No. 5. Art. 64.

7

Brain Structure and Function Dubois J., Grotheer M., Yang J.Y. et al. Small brains but big challenges: white matter tractography in early life samples // Brain Structure and Function. 2025. Vol. 230, No. 4. Art. 58.

8

Neurology Guberman G.I., Balasubramaniam N., Wilson L. et al. Diffusion MRI tractography to reduce risks of postoperative neurologic deficits: a systematic review and meta-analysis // Neurology. 2025. Vol. 105, No. 9. P. e214145.

9

Clinical Neurophysiology Jung J., Rajwani K., Mirallave-Pescador A. et al. Functional cortical mapping and structural subcortical anatomy predicts intra-operative speech arrest: a nTMS-tractography study // Clinical Neurophysiology. 2025. Vol. 179. Art. 2110995.

10