Preoperative surgical planning of glioma: Limitations and reliability of fMRI and DTI tractography

Brain mapping techniques (intraoperative neurophysiology and intraoperative neuropsychology) represent the gold standard in glioma surgery; these techniques have been proven to be the gold standard in glioma resection. From the introduction of MRI in clinical routine, several advanced applications have been developed like functional MRI and tractography based on diffusion imaging. Both techniques have application in glioma surgery. The fMRI allows to identify cortical areas related to a specific function, DTI allow to reconstruct a model of the sub-cortical connectivity. This paper describes the clinical application of fMRI and DTI tractography, enlightening sensitivity and specificity in comparison to gold standard and underlining their limitation in surgical decision making.