Abstract

Background

Due to their infiltrative nature and proximity to critical brain structures, low-grade gliomas (LGGs) pose significant challenges in neurosurgical management. Recent advancements in Diffusion Tensor Imaging (DTI) have revolutionized the visualization of white matter tracts, enabling surgeons to navigate these complex landscapes with greater precision. This abstract examines the integration of DTI-based excision techniques for LGGs as a crucial step toward the broader application of Brain-Computer Interfaces (BCIs) in neurosurgery.

DTI facilitates a comprehensive understanding of the relationship between tumor architecture and neural pathways, significantly improving surgical outcomes. By employing DTI-guided surgical planning, neurosurgeons can minimize neurological deficits and enhance the extent of resection, which is pivotal for patient prognosis, thus establishing a foundation for incorporating BCI to improve surgical capabilities further.

Methodology
A prospective study was conducted at Neurosurgery Unit-II of the Punjab Institute of Neurosciences, Lahore, over one year from November 2023 to October 2024. A total of 25 patients meeting the inclusion criteria were included in the study. Before surgical intervention, all patients underwent MR imaging utilizing a neuronavigation protocol and Diffusion-Tensor Imaging. Outcomes were analyzed based on key metrics: (a) Extent of resection, (b) Functional outcomes, and (c) Patient survival, with follow-up evaluations at immediate post-operation, one-month, and three-month intervals.

Results
The study included 25 patients, 14 males (56%) and 11 females (44%), aged 18 to 60. Pre-operative imaging, along with Diffusion Tensor Imaging (DTI), was utilized to plan surgical corridors based on the involvement of white matter tracts to maximize resection while preserving white matter tracts. Gross total resection was achieved in 19 patients (76%), while six patients (24%) underwent subtotal resection. Post-operatively, neurological deficits were observed in 5 patients (20%), with three patients (60% of deficits) experiencing motor weakness, one patient (20% of deficits) experiencing speech difficulty, and one patient (20% of deficits) experiencing visual disturbance. These deficits showed significant improvement by the 3-month follow-up.

Conclusion
In conclusion, diffusion tensor imaging (DTI) enhances surgical outcomes when excisioning low-grade gliomas. It represents a significant advancement in neurosurgery's use of Brain-Computer Interfaces (BCIs). This multidisciplinary approach has the potential to redefine surgical paradigms and improve the quality of life for patients undergoing treatment for brain tumors.