Khursheed Alam Khan1, Shashi Kant Jain2, Virendra Deo Sinha1, Jyotsna Sinha3. 1. Department of Neurosurgery, Sawai Maan Singh Medical College, Jaipur, India. 2. Department of Neurosurgery, Sawai Maan Singh Medical College, Jaipur, India. Electronic address: shashi_neelu@yahoo.com. 3. Department of Radiology, Getwell Clinic, Jaipur, India.
Abstract
BACKGROUND AND OBJECTIVE: In view of the few large prospective studies available on the role of preoperative diffusion tensor imaging (DTI), and the potential of DTI in showing the relationship between tumor and white matter tracts, we studied the role of preoperative DTI in planning a safe surgical corridor, predicting the neurologic and surgical outcome and tumor characterization in supratentorial intra-axial brain tumors. METHODS: We included 128 cases. Preoperative neurologic status and tumor volume were assessed. A magnetic resonance imaging (MRI)-based surgical plan was decided and reviewed for changes after DTI (site of corticotomy or limit of resection) by senior faculty of neurosurgery and neuroradiologist. Tracts were classified as displaced, infiltrated, or disrupted. Postoperative neurologic and surgical outcome was assessed along with evaluation of association of DTI with tumor type. RESULTS: DTI-based change in surgical corridor was seen in 60 patients (47%). Sixty-six patients harbored low-grade gliomas, 48 had high-grade gliomas, and 14 had metastastic lesions. Resectability (maximum safe resection) was higher in patients with displaced fibers and lower in those with disrupted/infiltrated fibers, which was statistically significant. Fewer patients had neurologic deterioration in the displaced category (7.1%) compared with the disrupted/infiltrated category (13.9%). Although no significant association could be established between neurologic outcome and fiber type, displaced fibers were associated mainly with low-grade glioma (71%), whereas disrupted/infiltrated fibers were associated mainly with high-grade glioma (66%); this correlation was significant. CONCLUSIONS: Preoperative DTI is a landmark tool for planning a safe surgical corridor and predicting the tumor type along with neurologic and surgical outcome of patients.
BACKGROUND AND OBJECTIVE: In view of the few large prospective studies available on the role of preoperative diffusion tensor imaging (DTI), and the potential of DTI in showing the relationship between tumor and white matter tracts, we studied the role of preoperative DTI in planning a safe surgical corridor, predicting the neurologic and surgical outcome and tumor characterization in supratentorial intra-axial brain tumors. METHODS: We included 128 cases. Preoperative neurologic status and tumor volume were assessed. A magnetic resonance imaging (MRI)-based surgical plan was decided and reviewed for changes after DTI (site of corticotomy or limit of resection) by senior faculty of neurosurgery and neuroradiologist. Tracts were classified as displaced, infiltrated, or disrupted. Postoperative neurologic and surgical outcome was assessed along with evaluation of association of DTI with tumor type. RESULTS: DTI-based change in surgical corridor was seen in 60 patients (47%). Sixty-six patients harbored low-grade gliomas, 48 had high-grade gliomas, and 14 had metastastic lesions. Resectability (maximum safe resection) was higher in patients with displaced fibers and lower in those with disrupted/infiltrated fibers, which was statistically significant. Fewer patients had neurologic deterioration in the displaced category (7.1%) compared with the disrupted/infiltrated category (13.9%). Although no significant association could be established between neurologic outcome and fiber type, displaced fibers were associated mainly with low-grade glioma (71%), whereas disrupted/infiltrated fibers were associated mainly with high-grade glioma (66%); this correlation was significant. CONCLUSIONS: Preoperative DTI is a landmark tool for planning a safe surgical corridor and predicting the tumor type along with neurologic and surgical outcome of patients.