MR Tractography In Pediatric Subcortical Brain Tumors as A Tool for Improving Surgical Decision-Making
Аннотация
Magnetic resonance tractography has become an important adjunct in the preoperative assessment of brain tumors, particularly in cases involving functionally eloquent regions. In pediatric patients with subcortical tumors, where anatomical variability and ongoing neurodevelopment complicate surgical planning, tractography provides an additional layer of information for visualizing white matter pathways and estimating the risk of functional deficits. However, its clinical utility remains controversial due to methodological variability, model dependence, and limited reproducibility. This review critically evaluates current evidence on the use of MR tractography in the surgical management of pediatric subcortical brain tumors. A structured literature search was performed across major biomedical databases, focusing on studies published between 2017 and 2025. The analysis emphasizes clinical applications, integration with functional mapping, and methodological limitations affecting interpretation. Available data suggest that MR tractography improves spatial understanding of tumor–tract relationships and may influence surgical approach selection. At the same time, its predictive value for functional outcomes remains inconsistent, particularly in the presence of edema, tumor infiltration, and immature white matter. The lack of standardization and dependence on reconstruction algorithms continue to limit its reliability. MR tractography should therefore be regarded as a supportive rather than standalone modality. Its optimal use lies within a multimodal framework combining anatomical imaging, functional mapping, and intraoperative monitoring. Further standardization and validation studies are required to enhance its role in clinical decision-making.