SYSTEMATIC REVIEW article
Front. Neuroimaging
Sec. Neuroimaging Meta-Analyses
Volume 4 - 2025 | doi: 10.3389/fnimg.2025.1563996
The use of intraoperative tractography in brain tumour and epilepsy surgery: a systematic review and meta-analysis
Provisionally accepted
- 1Developmental Imaging and Biophysics Section, Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, England, United Kingdom
- 2Department of Medical Physics and Biomedical Engineering, Faculty of Engineering Sciences, University College London, London, England, United Kingdom
- 3Department of Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom
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Tractography is the only available technique for visualising white matter pathways within the living brain. Avoiding these pathways during surgical interventions for brain tumours and epilepsy is key to reducing postoperative neurological deficits whilst achieving maximum safe resection. Despite this, the use of intraoperative tractography is not widely adopted in clinical practice, with time required to run analyses often cited as a limitation. This systematic review and meta-analysis aimed to assess the impact of intraoperative tractography on neurosurgical outcomes in both tumour and epilepsy surgeries. Conducted in accordance with PRISMA guidelines, five major databases were searched using neurosurgery, tractography, brain tumour, and epilepsy terms.Original primary research studies in English were included. A risk of bias analysis was conducted using the MINORS tool. The search strategy identified 2611 papers. Following de-duplication and screening, 26 papers were included in the final analysis. Risk of bias was found to be moderate. Findings suggest that the use of intraoperative tractography has the potential to improve surgical outcomes for patients undergoing tumour and epilepsy surgery. Meta-analysis indicated a good rate of gross total resection, 79%, and only three studies of brain tumours and one study of epilepsy reported worsening of neurological deficits. Though the evidence supporting its use remains limited, results indicate that intraoperative tractography can be a valuable tool in improving neurosurgical outcomes and reducing the risk of postoperative deficits.Further research is required to determine optimal use in clinical practice.
Keywords: Diffusion Tensor Imaging, tractography, brain tumours, Epilepsy, Neurosurgery
Received: 20 Jan 2025; Accepted: 19 May 2025.
Copyright: © 2025 Aylmore, Young, Aquilina, Clark and Clayden. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Holly Aylmore, Developmental Imaging and Biophysics Section, Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, University College London, London, WC1N 1EH, England, United Kingdom
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