Surgery is usually the first line of treatment for a brain tumor.
Doctors and researchers are examining methods to improve the surgery procedures, because brain tumors are nestled in vital areas of the brain. Surgeons want to remove the tumor and have as little impact on the brain of the patient as possible. To do that, very detailed imaging of the brain is needed.
St. Jude Children's Research Hospital doctors are using a technique called diffusion tensor imaging (DTI). This method provides images with more detail than conventional MRI imaging, allowing doctors to better map out a tumor's proximity to nerve tracts and plan the dissection. DTI captures information about water diffusion within fiber tracts. The technique provides colorful images of the brain showing 3-D views of the tumor and the nerve tracts.
"It turns out the brain is a highly organized structure that has these pathways along which water diffuses more readily than others. So, by using this MRI measurement we can assess the diffusion properties of the water in the brain primarily to map out the cabling, or the wiring, of the brain," radiological scientist Robert Ogg said.
Ogg said the doctors there have had patients with tumors located close to very critical structures in the brain. For example, a tumor could be next to the white matter areas connecting the parts of the brain responsible for controlling a person's hands.
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Diffusion tensor imaging
DTI is helping surgeons remove tumors in the brain with more precision than ever.
 
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"If there is a tumor in that area when the surgeon goes in, he needs to be very careful to avoid, not only the superficial cortical part of the brain that is deciding what to do and telling the hands what to do, but then the connection that takes that signal down to your hands. If either of those are compromised, then the patient loses the use of that hand," Ogg said.
Other important areas surgeons need to avoid are the language centers.
"If a patient has a tumor in certain areas in the left side of their brain known to be involved in production of speech or understanding of auditory speech, then we know if certain parts of the brain are damaged during surgery, then you could leave the child unable to speak or understand communication, which can be pretty devastating," Ogg said.
Using the DTI technique, surgeons can be sure they will avoid these critical areas.
