Objective To evaluate the value of incorporating fMRI into DTT in the operational assessment of lesions involving the motor hand representation tracts in patients.Methods 20 patients with lesions involving the motor hand representation tracts underwent 3D T1-weighted imaging for anatomical reference,a gradient echo planar imaging sequence for fMRI,and a spin echo-echo planar imaging sequence for DTI.We used two regions of interest (ROI) to define 3D connectivity maps within the whole brain,from seed points selected in the white matter adjacent to the location of the maximum of fMRI activation,and the target region of interest (ROI) was placed in the cerebral peduncle.During surgery,the border of the tumor was identified using neuronavigation and intraoperative ultrasonography for protecting deep white matter and enhancing the accuracy of resection.Results Total lesion resection was achieved in 16 patients,and subtotal resection in 4 cases.In 20 patients,we successfully tracked the motor hand representation tracts by choosing seed and target regions of interest on the path of the fibers.Moreover,no obvious harmful effects to the motor areas and adjacent fibers were observed in all patients.Condusions fMRI-driven DTT can provide the ability to evaluate the spatial relationship between the motor tracts and tumor borders.Not only has the new technology provided a maximum benefit in surgical treatment and improved preoperative planning,it also enhanced the accuracy of postsurgical outcomes.