Relative anterior safe area for invasive procedures in the human brain: Diffusion tensor tractography

Objective: Many interventions, including surgery, procedures of shunt operation, or radiotherapy could result in neural injury of the brain. However, research to prevent or minimize injury of neural tracts has been overlooked. Material and methods: We recruited 41 healthy subjects. Diffusion tensor images were acquired and five neural tracts were reconstructed (corticospinal tract, corticoreticular pathway, arcuate fasciculus, cingulum, and superior longitudinal fasciculus). We defined the safe area, which is an area free from any trajectory of five neural tracts: the medial boundary - the most lateral point free from any trajectory of five neural tracts, the posterior boundary - the most anterior point free from any trajectory of five neural tracts. Results: Medial boundaries of the safe area in the cortex, centrum semiovale, corona radiata, and internal capsule were located at an average of 0 mm, 12.28 mm, 12.43 mm, and 10.34 mm laterally from the midline, respectively, and the posterior boundaries were located at an average of 1.30 mm, 4.26 mm, 7.05 mm, and 5.74 mm from the ACL, respectively. In addition, we found that the common safe areas for all four axial levels were located at 13.44 mm (medial boundary) and 9.35 mm (posterior boundary). Conclusion: We identified a relatively safe area for the performance of invasive procedures in the anterior portion of the human brain.