Bilateral cingulotomy is a procedure applied to patients with obsessive–compulsive disorder (OCD). This report presents the structural changes occurring within the forceps minor and arcuate fascicles nerve fibers after a successful bilateral anterior cingulotomy in the patient with refractory OCD. Cingulotomy mainly affects the values of FA, MD, and ADC in the treatment of the examined nerve bundles. This structural reorganization coexists with a good clinical effect. However, it is necessary to expand the study group and to investigate the correlation between the parameters of diffusion and anisotropy and the patient’s clinical condition (Y-BOCS scale).

Diffusion tensor-based tractography enables non-invasive reconstruction of white matter pathways in the human brain using two main algorithms: deterministic and probabilistic. Deterministic tractography generates white matter filaments that follow the dominant diffusion direction in individual voxels, providing fast but imprecise reconstruction; however, it is limited in areas with crossed filaments. Probabilistic tractography, on the other hand, models uncertainty and allows for more accurate mapping of complex neural connections, although it is computationally demanding and more difficult to interpret. This article discusses the theoretical foundations, strengths and weaknesses, and clinical applications of both approaches, with particular emphasis on their application in neurosurgery and neuroradiology.