Shi Jianwei, Lu Dafeng, Pan Ruihan, Chen Hairong, Teng Hong, Xu Yang, Bo Fuduo, Zhou Qi, Zhang Yansong
Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
School of Public Health, Nanjing Medical University, Nanjing, China.
Front Oncol. 2022 Aug 16;12:955418. doi: 10.3389/fonc.2022.955418. eCollection 2022.
Intracranial tumors involving the temporo-occipital lobe often compress or destroy the optic radiation (OpR), resulting in decreased visual function. The aim of this study is to explore the value of diffusion tensor imaging (DTI) tractography integrated with neuronavigation to prevent visual damage when resecting tumors involving the OpR and find potential factors affecting patients' visual function and quality of life (QOL).
Our study is a cross-sectional study that included 28 patients with intracranial tumors in close morphological relationship with the OpR recruited between January 2020 and February 2022. The surgical incision and approach were preoperatively designed and adjusted according to the DTI tractography results and visual function scores. All patients underwent examinations of visual acuity (VA) and visual field index (VFI) and completed visual function and QOL scales at admission and 2 months after discharge. Logistic regression and linear regression analysis were conducted to evaluate clinical factors potentially affecting pre/postoperative OpR morphology, VA, VFI, visual function, and QOL.
Lesion size was the main factor found to affect visual function (β = -0.74, 95%CI: -1.12-0.36, P = 0.05), VA (left: β = -0.11, 95%CI: -0.14-0.08, P < 0.001; right: β = -0.15, 95%CI: -0.17-0.13, P < 0.001), and VFI (left: β = -0.11, 95%CI: -0.14-0.08, P < 0.001; right: β = -0.14, 95%CI: -0.16~-0.12, P < 0.001). Lesion size, edema, and involvement of the lateral ventricle temporal horn were factors affecting OpR morphology and QOL. The 28 patients showed significantly improved VA, VFI, visual function, and QOL results (P < 0.05) 2 months after discharge.
Combining DTI of OpR mapping and microscopic-based neuronavigation aided precise mapping and thus preservation of visual function in patients undergoing tumor resection. Potential clinical factors affecting patients' visual function and QOL scores were identified which are useful for assessing a patient's condition and predicting prognosis.
累及颞枕叶的颅内肿瘤常压迫或破坏视辐射（OpR），导致视功能下降。本研究旨在探讨弥散张量成像（DTI）纤维束成像联合神经导航在切除累及OpR的肿瘤时预防视功能损害的价值，并找出影响患者视功能和生活质量（QOL）的潜在因素。
本研究为横断面研究，纳入了2020年1月至2022年2月期间招募的28例与OpR形态关系密切的颅内肿瘤患者。根据DTI纤维束成像结果和视功能评分，术前设计并调整手术切口和入路。所有患者在入院时和出院后2个月接受视力（VA）和视野指数（VFI）检查，并完成视功能和QOL量表。进行逻辑回归和线性回归分析，以评估可能影响术前/术后OpR形态、VA、VFI、视功能和QOL的临床因素。
发现病变大小是影响视功能（β = -0.74，95%CI：-1.12-0.36，P = 0.05）、VA（左侧：β = -0.11，95%CI：-0.14-0.08，P < 0.001；右侧：β = -0.15，95%CI：-0.17-0.13，P < 0.001）和VFI（左侧：β = -0.11，95%CI：-0.14-0.08，P < 0.001；右侧：β = -0.14，95%CI：-0.16~-0.12，P < 0.001）的主要因素。病变大小、水肿和侧脑室颞角受累是影响OpR形态和QOL的因素。28例患者出院后2个月时VA、VFI、视功能和QOL结果均有显著改善（P < 0.05）。
OpR映射的DTI与基于显微镜的神经导航相结合有助于精确映射，从而在肿瘤切除患者中保留视功能。确定了影响患者视功能和QOL评分的潜在临床因素，这有助于评估患者病情和预测预后。
