[HARDI-CSD tractography in determining the structure of diencephalic pathways in craniopharyngiomas].

Craniopharyngioma is a benign tumor in adults and children characterized by local invasion of surrounding brain structures. HARDI-CSD tractography is one of the modern MR methods for comprehensive visualization of functionally significant conduction pathways.

Objective: To determine the possibility of visualizing some structures of chiasmatic-sellar region and third ventricle (hypothalamic-pituitary tract (pituitary stalk), optic pathways, fornix, mammillothalamic tract) using HARDI-CSD tractography in patients with suprasellar craniopharyngiomas, especially after failed CT and standard MRI of these structures.

Material and methods: A pilot study included 4 patients (2 adults and 2 children) with craniopharyngiomas who underwent surgical treatment at the Burdenko Neurosurgery Center between January and July 2024. Patients underwent MR tractography before and after surgery.

Results: HARDI-CSD tractography reconstructed optic tracts in 3 patients before and after surgery. Simultaneous visualization of several structures (pituitary stalk, fornix, optic tracts) was performed before and after surgery in 1 case. These data were useful for planning surgery and evaluating postoperative outcomes. In one patient, imaging of mammillothalamic tract was obtained after resection of large cystic intra-extraventricular craniopharyngioma.

Conclusion: HARDI-CSD tractography provides valuable information about basal cerebral pathways (optic pathways, pituitary stalk, fornix, mammillothalamic tract) when planning and evaluating the results of surgical treatment of craniopharyngiomas.