Pediatric subcortical supratentorial tumors represent a complex group of intracerebral neoplasms characterized by heterogeneous clinical presentation and variable relationships with functionally significant white matter pathways. Conventional magnetic resonance imaging provides important anatomical information; however, its ability to assess the functional-topographic organization of subcortical white matter remains limited. To evaluate the clinical and radiological features of pediatric subcortical supratentorial tumors and to determine the diagnostic value of MR tractography in assessing tumor relationships with functionally significant white matter pathways during preoperative planning. This retrospective study included 100 pediatric patients with subcortical supratentorial tumors who underwent standard magnetic resonance imaging and diffusion tensor MR tractography before surgical treatment. Clinical presentation, conventional MRI characteristics, tractographic patterns of tumor-white matter interaction, intraoperative findings, and postoperative neurological outcomes were analyzed comparatively. A control group of 20 neurologically healthy pediatric subjects was additionally evaluated to characterize normal tractographic anatomy. Conventional MRI demonstrated considerable variability in tumor morphology, contour characteristics, perifocal edema, and mass effect across different subcortical localizations, limiting the reliability of standard anatomical assessment. MR tractography revealed a broad spectrum of tumor–tract relationships, including tract displacement, deformation, thinning, and partial involvement. Moderate tract displacement represented the most frequent tractographic pattern. More severe tractographic abnormalities were associated with a progressively higher incidence of persistent postoperative neurological deficits. Tractographic findings demonstrated high concordance with intraoperative observations, confirming the clinical relevance of preoperative tractographic assessment. MR tractography provides clinically significant functional-topographic information that cannot be reliably obtained using conventional MRI alone. Integration of tractographic analysis into preoperative evaluation may improve surgical planning and facilitate more accurate assessment of functional risk in children with subcortical supratentorial tumors.

Pediatric brain tumors, subcortical supratentorial tumors, magnetic resonance imaging

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