In:
Neuro-Oncology, Oxford University Press (OUP), Vol. 24, No. Supplement_4 ( 2022-10-01), p. iv6-iv6
Abstract:
Despite evidence of correspondence with intraoperative stimulation, there remains limited data on MRI diffusion tractography (DT)’s sensitivity to predict morbidity after brain tumour resection. Our aims were: (1) evaluate DT against subcortical stimulation mapping and performance changes during and following awake surgery; (2) evaluate the use of early post-operative DT to predict recovery from post-surgical deficits. METHOD We performed a retrospective review our first 100 awake neurosurgery procedures using DTneuronavigation. Intra-operative stimulation and performance outcomes were assessed to classify DT predictions for sensitivity and specificity calculations. RESULTS Between 2014 and 2019 a total of 91 adult brain tumour patients (mean age 49.2 years) underwent 100 awake surgeries with subcortical stimulation. The sensitivity and specificity of pre-operative DT predictions were 92.2% and 69.2%, varying among tracts. Post-operative deficits occurred after 41 procedures (39%), but were prolonged ( & gt;3 months) in only 4 patients (4%). Post-operative DT was available in 51 patients and confirmed surgical preservation of tracts. Post-operative DT anticipated complete recovery in a patient with supplementary motor area syndrome, and indicated infarct-related damage to corticospinal fibers associated with delayed, partial recovery in a second patient. CONCLUSION Pre-operative DT provided very accurate predictions of the spatial location of tracts in relation to a tumour. As expected, however, the presence of a tract did not provide information on its functional status, resulting in variable DT specificity among individual tracts. While prolonged deficits were rare in our series, DT in the immediate post-operative period offered additional information to monitor neurological deficits and anticipate recovery potential.
Type of Medium:
Online Resource
ISSN:
1522-8517
,
1523-5866
DOI:
10.1093/neuonc/noac200.024
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2022
detail.hit.zdb_id:
2094060-9
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