Outcomes of diffusion tensor tractography-integrated stereotactic radiosurgery

Tomoyuki Koga, Keisuke Maruyama, Kyousuke Kamada, Takahiro Ota, Masahiro Shin, Daisuke Itoh, Naoto Kunii, Kenji Ino, Atsuro Terahara, Shigeki Aoki, Yoshitaka Masutani, Nobuhito Saito

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Purpose: To analyze the effect of use of tractography of the critical brain white matter fibers created from diffusion tensor magnetic resonance imaging on reduction of morbidity associated with radiosurgery. Methods and Materials: Tractography of the pyramidal tract has been integrated since February 2004 if lesions are adjacent to it, the optic radiation since May 2006, and the arcuate fasciculus since October 2007. By visually confirming the precise location of these fibers, the dose to these fiber tracts was optimized. One hundred forty-four consecutive patients with cerebral arteriovenous malformations who underwent radiosurgery with this technique between February 2004 and December 2009 were analyzed. Results: Tractography was prospectively integrated in 71 of 155 treatments for 144 patients. The pyramidal tract was visualized in 45, the optic radiation in 22, and the arcuate fasciculus in 13 (two tracts in 9). During the follow-up period of 3 to 72 months (median, 23 months) after the procedure, 1 patient showed permanent worsening of pre-existing dysesthesia, and another patient exhibited mild transient hemiparesis 12 months later but fully recovered after oral administration of corticosteroid agents. Two patients had transient speech disturbance before starting integration of the arcuate fasciculus tractography, but no patient thereafter. Conclusion: Integrating tractography helped prevent morbidity of radiosurgery in patients with brain arteriovenous malformations.

Original languageEnglish (US)
Pages (from-to)799-802
Number of pages4
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number2
StatePublished - Feb 1 2012
Externally publishedYes


  • Arteriovenous malformation
  • Diffusion tensor tractography
  • Gamma knife
  • Morbidity
  • Stereotactic radiosurgery


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