A 68-year-old with a history of prostate cancer presented with right-sided hearing loss over seven years. The patient had no focal neurological deficits. T2 weighted magnetic resonance imaging (MRI) identified a left parietal and anterior temporal mass suggestive of a low-grade glioma confirmed by partial resection biopsy.

Diffusion Tensor Imaging (DTI) enables noninvasive, in vivo, visualization of white matter tracts of the nervous system by measuring the diffusion of water molecules. It consists of quantitative (DTI-indices) and qualitative (tractography) data to evaluate regions-of-interest. VR leverages advancements in computing and headset technology to generate interactive experiences. This technology has promising applications in medical education, preoperative planning, and intraoperative navigation.

To present a novel application of 3D modeling in a case of low-grade glioma incorporating whole brain tractography and virtual reality(VR).

Computer tomography (CT) data was acquired with thin slices(<1mm). DTI protocol included a T1-weighted 3D magnetization-prepared rapid acquisition gradient echo sequence. 3D Slicer (Brigham and Women’s Hospital, USA) processed the images to produce the anatomical structures and white matter tractography (WMT). Files were imported into our internally-developed medical VR application.

When applied by the surgeon, our VR model allowed for better visualization of relationships between tumor and adjacent structures during resection

Tractography is a valuable technique in surgical planning.^1-3 WMT-based surgery is recognized for balancing the trade-off between preserving function and maximizing resection of gliomas. Tracts display alterations including: mass effect, tumor infiltration, edema, and functional reorganization.⁴. Visualization of aforementioned features provides surgeons spatial information to plan procedures from craniotomy to specific tumor resection. Understanding spatial relationships and tract position relative to the tumor is fundamental to neuro-oncological intervention. VR may improve operative planning, reduce operating time and complications.^5,6 Future studies will assess the utility and efficacy of this technology in complex neurosurgical procedures.