The role of diffusion tensor imaging in brain tumor surgery: A review of the literature

• We outline the pitfalls and benefits of DTI as a tool for neurosurgical planning.
• DTI is a promising technique for neuronavigation in tumor surgery.
• DTI has a role in multimodal navigation during brain tumor surgery.

Diffusion tensor imaging (DTI) is a recent technique that utilizes diffusion of water molecules to make assumptions about white matter tract architecture of the brain. Early on, neurosurgeons recognized its potential value in neurosurgical planning, as it is the only technique that offers the possibility for in vivo visualization of white matter tracts. In this review we give an overview of the current advances made with this technique in neurosurgical practice. The effect of brain shift and the limitations of the technique are highlighted, followed by a comprehensive discussion on its objective value. Although there are many limitations and pitfalls associated with this technique, DTI can provide valuable additional diagnostic information to the neurosurgeon. We conclude that current evidence supports a role for DTI in the multimodal navigation during tumor surgery.