A 38-year-old right-handed male presented with left glioblastoma, suffering from weakness in his right upper and lower extremities. MRI examination revealed an intra-axial tumor in the left temporal-parietal region. His language function was normal. The FA map showed decreased intralesional FA value, indicating the infiltration and destruction of WM tracts. The color-coded map showed complete disruption of the WM tracts of inferior fronto-occipital fasciculus (IFO) fibers. 3-D fiber tractography showed the intact left corticospinal tract (CST) in close relation to the lesion. The left CST was shown to be compressed and deviated medially by the mass lesion. The left arcuate fasciculus (AF) was seen away from the lesion, and unaffected by the same. Normal intact left-sided CST, IFO and AF tracts are shown for comparison. The tumor was resected maximally, avoiding the CST and AF, and was followed by chemoradiation (Figure ).
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 ).