Analysis of Diffusion Tensor Imaging for neurosurgical applications: tumor removal in eloquent areas.

The purpose of the thesis is to investigate a clinical application of Diffusion Tensor Imaging in brain surgery. Brain Surgery aims to maximize lesion resection while preserving surrounding vital cortical and subcortical area. MRI techniques enables neurosurgeons to define how lesions change the individual anatomy in relation to brain function mapping. In this thesis we describe principles and methods of diffusion model and specific neuro radiological protocols for pre surgical planning (minimal risk strategy) of malignant brain tumors in eloquent area. Despite artifacts and limits, the developed framework based on DTI integrated with intra-operative localization supports neurosurgeon to analyze surgical strategies while preserving brain functions. We compare methods, procedures and different implementation of algorithms affecting the complex multi-modal processing of imaging protocol. Clinical information (deficit quantification), and intra-operative neurophysiological stimulations with morphological characteristics of fiber bundles corrupted by tumor is widely examined. From January 2011 to December 2013, 144 patients with lesions in eloquent areas were submitted to pre-operative DTI tractography and 94 of 144 were treated surgically.