Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany.
Institute of Neuroradiology, University Hospital Leipzig, 04103 Leipzig, Germany.
J Integr Neurosci. 2022 Sep 19;21(6):149. doi: 10.31083/j.jin2106149.
Tractography has become a standard tool for planning neurosurgical operations and has been proven to be useful for risk stratification. In various conditions, tractography-derived white matter integrity has been shown to be associated with neurological outcome. Postoperative performance has been shown to be a prognostic marker in glioma. We aimed to assess the relation of preoperative corticospinal tract (CST) integrity with postoperative neurological deterioration in patients with malignant glioma.
We retrospectively analyzed a cohort of 24 right-handed patients (41.7% female) for perioperative neurological performance score (NPS) and applied our anatomical tractography workflow to extract the median fractional anisotropy (FA) of the CST in preoperative magnetic resonance imaging (MRI).
Median FA of the CST ipsilateral to the tumor correlated significantly with preoperative NPS ( = 0.025). After rank order correlation and multivariate linear regression, we found that the preoperative median FA of the right CST correlates with preoperative NPS, independently from epidemiological data ( = 0.019). In patients with lesions of the right hemisphere, median FA of the right CST was associated with a declining NPS in multivariate linear regression ( = 0.024). Receiver operating characteristic (ROC) analysis revealed an optimal FA cutoff at 0.3946 in this subgroup (area under the curve 0.83). Patients below that cutoff suffered from a decline in neurological performance significantly more often ( = 0.020).
Assessment of preoperative white matter integrity may be a promising biomarker for risk estimation of patients undergoing craniotomy for resection of malignant glioma.
示踪已成为规划神经外科手术的标准工具，并已被证明对风险分层有用。在各种情况下，示踪所得的白质完整性与神经功能预后相关。术后表现已被证明是胶质瘤的预后标志物。我们旨在评估恶性胶质瘤患者术前皮质脊髓束（CST）完整性与术后神经恶化的关系。
我们回顾性分析了 24 名右利手患者（41.7%为女性）的围手术期神经功能评分（NPS），并应用我们的解剖示踪工作流程提取术前磁共振成像（MRI）中 CST 的中位数各向异性分数（FA）。
肿瘤对侧 CST 的中位数 FA 与术前 NPS 显著相关（ = 0.025）。经过秩相关和多元线性回归分析，我们发现右侧 CST 的术前中位数 FA 与术前 NPS 相关，与人口统计学数据无关（ = 0.019）。在右侧半球病变的患者中，右侧 CST 的中位数 FA 与多元线性回归中的 NPS 下降相关（ = 0.024）。ROC 分析显示该亚组的最佳 FA 截断值为 0.3946（曲线下面积为 0.83）。低于该截断值的患者神经功能恶化的发生率明显更高（ = 0.020）。
术前白质完整性的评估可能是评估接受开颅切除恶性胶质瘤患者风险的有前途的生物标志物。
