A 34-year-old right-handed female developed an episode of partial epilepsy with transient language disorder. She recovered completely after few minutes of a seizure episode. MRI showed the left insular lesion characteristic for low-grade glioma. Pre-operative DTI was done to demonstrate the relationship of a lesion to eloquent areas to allow maximum tumor resection and to avoid tumor recurrence and damage to vital areas, such as language and motor function. Axial whole brain tractography showed destruction and distortion of the left frontal fibers and the left IFO tract. Anterior part of arcuate fasciculus (AF) was seen in close relation to the anterior-superior part of the lesion. The left CST was intact, yet medially deviated (Figure ).
A 24-year-old male presented with right frontal-parietal glioblastoma. The FA and color-coded maps showed decreased FA value and destruction of white matter fibers. 3D tractography was initiated from the brain stem for CST. The right CST passing through the periphery of the lesion was compressed and deviated anteromedially by the lesion. The AF was compressed and deviated superiorly by the lesion, and was close to the tumor margin (Figure ).