Survey assessment of utility in the preoperative magnetic resonance (MR) tractography surgical planning

While tractography guided surgery is used by many surgeons, there is controversy in the published literature as it relates to its clinical utility. Here we adopted a survey-based approach with the goal of attaining a broader view of how tractography influence pre-operative planning in a sampling of practicing neurosurgeons. Three cases were prepared where the presence of a tumor distorted the optic radiation (case 1), the arcuate fasciculus (case 2), and corticospinal tract (case 3). This survey was administered at the Medtronic Cranial Consortium attended by twenty practicing neurosurgeons. To avoid commercial bias, we used both the Brainlab and the Medtronic platform to compute tractography. Each participant is asked to vote on a surgical trajectory prior to and after seeing the tractography images as well as whether tractography added value in validating their surgical approach. In the three cases surveyed, 16-44% of the surgeons changed the surgical corridor selected after seeing the tractography images. The most common finding associated with a change in surgical corridor involved intersection of the surgical corridor with visualized tracts. Consistently, >80% of the surgeons surveyed felt that tractography added value in their surgical planning. The clinical utility of tractography in pre-operative planning vary as a function of surgeon and the tumor anatomy, with > 80% of the participating surgeons consider that tractography added value in pre-operative surgical planning.