Tracttargeted

Tract-targeted is a term used to describe approaches that identify and interact with specific neural white matter pathways, or tracts, during diagnosis, planning, or therapy. The aim is to preserve critical pathways and to modulate circuits relevant to function or pathology.

Techniques rely on diffusion MRI tractography to map white matter tracts in vivo, often combined with structural MRI, functional MRI, and electrophysiological data. In surgical settings, tract-targeted planning informs resections or stimulator placement, helping ensure that important tracts such as the corticospinal tract or language pathways are preserved or targeted as needed. There are also approaches to deliver therapies along particular tracts or to modulate activity through tract-directed stimulation in neuromodulation.

In research, tract targeting contributes to understanding brain connectivity and circuit function; in clinical practice, it supports risk assessment and personalized treatment planning.

Limitations include the inherent uncertainties of tractography, including false positives and negatives, partial volume effects, and inter-individual variability. Accuracy depends on imaging quality and processing methods; intraoperative brain shift can affect alignment. Tract-targeted methods should be used as guides in conjunction with other data and clinical judgment.

History and status: The concept emerged with advances in diffusion imaging in the late 1990s and 2000s and has since become more integrated into neurosurgical planning and neuromodulation. There is no universal standard for tract-targeted methods; practices vary by institution and application.