UPMC Video Rounds - High Definition Fiber Tractography

Robert Friedlander, MD, chair, Department of Neurological Surgery:

One of the challenges when we evaluate patients with lesions in the brain is to understand how dangerous is to resect them if, and if they should be resected. With, for example, functional MRI or MEG, they really delineate the surface of the brain in a very straightforward manner for us to know exactly where the lesion is, and we can make decisions as to how to approach a lesion.

Now, when things become a lot more complicated is when the lesion's in the depth of the brain, does not come up to the surface. And from that point of view, we don't know exactly where the tracts that connect the different functions of the brain might be located. There is a new technique called high definition fiber tractography, which provides the connections within the brain. Once we see where these tracts are located, then we can make a decision if to operate, how to operate.

If there is a lesion in a part of the brain, the tracts that are close to it could be pushed laterally, could be pushed medial, could be on top, could be on the bottom, could be broken. And if you don't know that before surgery, that makes the resection of the lesion much riskier and more challenging. If you know exactly, you don't have to guess. If you know exactly where the tracts are in respect to the lesion, you can on the one hand develop a way to approach the lesion in a much safer way, and you can resect the lesion and try to minimize side effects towards the patients.

Learn more about the Department of Neurological Surgery at UPMC.