Evaluation of tractography parameters for dentato-rubro-thalamic tract reconstruction during pediatric posterior fossa tumor surgery

Objective: Intraoperative fiber tractography can help neurosurgeons in localizing eloquent tracts potentially displaced by tumors. In pediatric posterior fossa tumor (pPFT) patients, disturbances to the eloquent dentato-rubro-thalamic tract (DRTT) might contribute to cerebellar mutism syndrome. This study investigates the effect of fiber tractography parameters on DRTT reconstruction in pre- and intraoperative settings. Methods: T1-weighted and diffusion MRI data were acquired from ten pPFT patients and two healthy volunteers. The patients were scanned pre- and intraoperatively. The DRTT was reconstructed using multiple fiber orientation distribution (FOD) and angle thresholds. An expert panel evaluated tract reconstructions to identify optimal parameters in our dataset. The corticospinal tract (CST) served as a control. Relative tract volumes of the DRTT and the CST were calculated. Results: Diffusion MRI data were sufficient for reliable DRTT reconstruction in healthy volunteers. In most pPFT patients, an FOD of 0.01 and a 60° angle threshold were evaluated as optimal for DRTT reconstruction in our dataset. Preoperative DRTT reconstructions showed more reconstructed streamlines and larger relative volumes, particularly in non-decussating tracts. CST reconstructions remained consistent across both timepoints. Discussion: DRTT reconstruction is feasible in pPFT patients before and during surgery. However, inter-subject variability suggests that some patients may require adjusted thresholds for optimal results.