Diffusion MR tractography has rapidly become an important clinical tool that can delineate functionally important white matter tracts for surgical planning. One of the goals of brain surgery is to avoid damage to eloquent cortex and subcortical white matter. Diffusion tractography remains the only noninvasive method capable of segmenting the subcortical course of a white matter tract. This article reviews the technical and clinical issues surrounding presurgical diffusion tractography, including traditional diffusion tensor imaging methods and more advanced high angular resolution diffusion imaging approaches, such as q-ball imaging. An overview of the presurgical diffusion tensor imaging and q-ball tractography protocols used at our institution is also provided.