Limited Positive Predictive Value of Diffusion Tensor Tractography in Determining Clinically Relevant White Matter Damage in Brainstem Cavernous Malformations: A Retrospective Study in a Single Center Surgical Cohort.

Diffusion tensor tractography (DTT) might reflect the post-operative clinical outcome of the patients with brainstem (BS) tumors correlating well with the neurological symptoms, but cavernous malformation (CM) is a hemorrhagic tumor prone to artifacts that may limit DTT. We set out to determine the correlation of DTT findings with the neurological examination before and after surgical resection in patients with BSCMs.DTT findings were evaluated bilaterally for fiber tract displacement or deviation, deformation and interruption in every patient before and after the surgery. Neurological examination was performed at admission, discharge and outpatient follow-up visit.  The sensitivity, specificity, positive and negative predictive values of DTT were calculated both pre- and post-operatively.There were 25 patients (9 men 16 women) with a mean age of 39.5±13.9 years. The mean size of the CMs was 6909±8374 mm (range: 180 mm-38220 mm) The mean follow-up time was 42.7±23.2 months (range: 8 to 112 months). Pre-operatively, the sensitivity, specificity, positive and negative predictive values of DTT for corticospinal tracts (CST) and medial lemnisci (ML) were 100%, 60%, 38.4%, 100% and 87.5%, 11.7%, 31.8%, 66.6%, respectively. Post-operatively, the sensitivity, specificity, positive and negative predictive values of DTT for CSTs and ML were 100%, 64.7%, 40%, 100% and 100%, 0%, 33.3%, 66.6%, respectively.Positive findings on DTT such as fiber tract deviation, deformation, disruption or interruption should be taken cautiosly before drawing conclusions of a clinically relevant damage of white matter tracts.