Valor predictivo de la tractografía intratumoral en la detección de fascículos elocuentes en gliomas cerebrales: = Predictive value of intratumoral tractography to detect eloquent fascicles in brain gliomas

espanolEstudiamos la capacidad de la tractografia por DTI para predecir la presencia de areas funcionales en los gliomas difusos de bajo grado (GDBG). Se estudiaron 22 GDBG en areas elocuentes e intervenidos mediante estimulacion electrica intraoperatoria (EEI); Se realizo tractografia intratumoral prequirurgica identificando todos los fasciculos dentro del tumor. Se estudio la correlacion entre la tractografia prequirurgica y los puntos elocuentes intratumorales identificados con la EEI mediante sistemas de neuronavegacion y otra tractografia intratumoral postquirurgica. En 5 casos no se identifico ninguno de los principales fasciculos elocuentes mediante tractografia prequirurgica (via piramidal, fasciculo fronto-occipital inferior, fasciculo arcuato y fasciculo longitudinal inferior), en ninguno se identifico limite funcional realizandose una reseccion completa. En el resto se identificaron al menos uno de los principales fasciculos elocuentes dentro del tumor mediante tractografia prequirurgica, en todos se identifico un limite funcional intratumoral limitando la reseccion. Demostramos que la tractografia por DTI intratumoral permite predecir con alta fiabilidad areas elocuentes dentro de los GDBG. EnglishWe studied the ability of DTI tractography to predict the presence of functional areas in diffuse low-grade gliomas (DLLG). We selected 22 DLLG located in eloquent areas and operated by intraoperative electrical stimulation (IES). Preoperative intratumoral tractography was performed identifying all bundles within the tumor. The correlation between preoperative intratumoral tractography and eloquent points identified with the IES was done by using neuronavigation systems and new postsurgical intratumoral tractography. In 5 cases no major eloquent bundles were identified by preoperative tractography (pyramidal tract, inferior fronto-occipital fasciculus, arcuate fasciculus and inferior longitudinal fasciculus), no functional limit was identified performing total resection. Among the other DLLG at least one of the main eloquent fascicles was reconstructed within the tumor by preoperative tractography, in all of them a functional limit was identified and precluded total tumor resection. We demonstrated that intratumoral DTI tractography predicts with high reliability eloquent areas within DLLG.