Integrating Diffusion Tensor Imaging-Based Tractography into Deep Brain Stimulation Surgery: A Review of the Literature

Background: It has been generally accepted that deep brain stimulation (DBS) not only acts in the nucleus where it is being applied, as initially thought, but that chronic stimulation activates axons located in its scope, and that this activation can exert its effects in distant areas. Considering this, DBS target identification should be made based on techniques that identify white matter tracts, such as tractography, rather than only by identifying specific nuclei on conventional magnetic resonance imaging. Methods: In this study, we performed a review of the literature on the use of tractography in DBS surgery and provide an overview of the main results. Results: Tractography has been used in the field of DBS to help clarify relevant aspects in the selection of targets and in evaluating its therapeutic effects in movement disorders, psychiatric diseases and pain. Conclusions: Studies are scarce so far, but they have provided data that, if confirmed, may optimize DBS surgery. Tractography might become a routine tool for DBS surgery in the near future.