What is the best way to understand functional tracts to guide the surgical approach for tumor resection in patients unable to participate in functional MRI?

This is really a language question. Motor pathways can be mapped asleep regardless of cognitive status, and nothing done preoperatively replaces direct stimulation for language. The task is to build the best structural and functional model before surgery and then decide whether intraoperative language mapping is realistic.

Tractography is the foundation. Tensor-based DTI fails at crossing fibers and underestimates tracts in edema and infiltrative tumor, so multi-fiber models with probabilistic tracking should be used for the arcuate and superior longitudinal fasciculi, the inferior fronto-occipital fasciculus, and the frontal aslant tract. Tractography shows expected anatomy and gives a working deep boundary. A tract that appears absent in ...