儿童后颅窝肿瘤切除术后弥散张量成像指标与神经功能缺损的相关性
Association between postoperative DTI metrics and neurological deficits after posterior fossa tumor resection in children.
作者信息
Vedantam Aditya, Stormes Katie M, Gadgil Nisha, Kralik Stephen F, Aldave Guillermo, Lam Sandi K
机构信息
1Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and.
2Department of Radiology, Texas Children's Hospital, Houston, Texas.
出版信息
J Neurosurg Pediatr. 2019 Jul 19;24(4):364-370. doi: 10.3171/2019.5.PEDS1912. Print 2019 Oct 1.
OBJECTIVE
Resection of posterior fossa tumors in children may be associated with persistent neurological deficits. It is unclear if these neurological deficits are associated with persistent structural damage to the cerebellar pathways. The purpose of this research was to define longitudinal changes in diffusion tensor imaging (DTI) metrics in white matter cerebellar tracts and the clinical correlates of these metrics in children undergoing resection of posterior fossa tumors.
METHODS
Longitudinal brain DTI was performed in a cohort of pediatric patients who underwent resection of posterior fossa tumors. Fractional anisotropy (FA) of the superior cerebellar peduncles (SCPs) and middle cerebellar peduncles (MCPs) was measured on preoperative, postoperative, and follow-up DTI. Early postoperative (< 48 hours) and longer-term follow-up neurological deficits (mutism, ataxia, and extraocular movement dysfunction) were documented. Statistical analysis was performed to determine differences in FA values based on presence or absence of neurological deficits. Statistical significance was set at p < 0.05.
RESULTS
Twenty children (mean age 6.1 ± 4.1 years [SD], 12 males and 8 females) were included in this study. Follow-up DTI was performed at a median duration of 14.3 months after surgery, and the median duration of follow-up was 19.7 months. FA of the left SCP was significantly reduced on postoperative DTI in comparison with preoperative DTI (0.44 ± 0.07 vs 0.53 ± 0.1, p = 0.003). Presence of ataxia at follow-up was associated with a persistent reduction in the left SCP FA on follow-up DTI (0.43 ± 0.1 vs 0.55 ± 0.1, p = 0.016). Patients with early postoperative mutism who did not recover at follow-up had significantly decreased FA of the left SCP on early postoperative DTI in comparison with those who recovered (0.38 ± 0.05 vs 0.48 ± 0.06, p = 0.04).
CONCLUSIONS
DTI after resection of posterior fossa tumors in children shows that persistent reduction of SCP FA is associated with ataxia at follow-up.
目的
儿童后颅窝肿瘤切除术后可能会出现持续性神经功能缺损。目前尚不清楚这些神经功能缺损是否与小脑通路的持续性结构损伤有关。本研究的目的是确定儿童后颅窝肿瘤切除术后小脑白质束中扩散张量成像（DTI）指标的纵向变化以及这些指标与临床的相关性。
方法
对一组接受后颅窝肿瘤切除术的儿科患者进行纵向脑DTI检查。在术前、术后和随访DTI上测量小脑上脚（SCPs）和小脑中脚（MCPs）的分数各向异性（FA）。记录术后早期（<48小时）和长期随访的神经功能缺损（缄默症、共济失调和眼球运动功能障碍）。进行统计分析以确定基于有无神经功能缺损的FA值差异。设定统计学显著性为p<0.05。
结果
本研究纳入了20名儿童（平均年龄6.1±4.1岁[标准差]，12名男性和8名女性）。术后DTI随访的中位时间为术后14.3个月，随访的中位时间为19.7个月。与术前DTI相比，术后DTI上左侧SCP的FA显著降低（0.44±0.07对0.53±0.1，p=0.003）。随访时存在共济失调与随访DTI上左侧SCP的FA持续降低有关（0.43±0.1对0.55±0.1，p=0.016）。术后早期缄默症且随访时未恢复的患者与恢复的患者相比，术后早期DTI上左侧SCP的FA显著降低（0.38±0.05对0.48±0.06，p=0.04）。
结论
儿童后颅窝肿瘤切除术后的DTI显示，SCP的FA持续降低与随访时的共济失调有关。
Zotero 插件