Horikawa Yoichiro, Yuri Takuma, Umaba Chinatsu, Yamawaki Rie, Nankaku Manabu, Ikeguchi Ryosuke, Arakawa Yoshiki
Rehabilitation Unit, Kyoto University Hospital, Kyoto, JPN.
Department of Occupational Therapy, Faculty of Health Science, Kyoto Tachibana University, Kyoto, JPN.
Cureus. 2025 Apr 21;17(4):e82747. doi: 10.7759/cureus.82747. eCollection 2025 Apr.
Motor function deterioration is a common postoperative complication in glioma patients, affecting daily activities. Although continuous rehabilitation is essential for motor recovery, the underlying cause of postoperative decline remains unclear. This case study investigates the temporal relationship between motor function, corticospinal tract (CST) fractional anisotropy (FA), and edema in a glioma patient following awake craniotomy. A 43-year-old Japanese man with recurrent left parietal glioma and right spastic hemiparesis underwent seven tumor resections over 12 years, culminating in an awake craniotomy. He experienced postoperative motor decline and underwent continuous rehabilitation. FA values of the CST and motor function were assessed preoperatively and on postoperative days 12, 29, and 134. Magnetic resonance imaging (MRI), T2 fluid-attenuated inversion recovery (FLAIR) was used to monitor edema progression. On postoperative day 12, a significant increase in edema was observed in the frontoparietal region, coinciding with a decline in FA and motor function. However, by postoperative days 29 and 134, edema had decreased, and both FA and motor function improved. The findings suggest that vasogenic edema contributed to the transient motor decline, as evidenced by the reversible FA changes, suggesting that CST integrity assessment via FA and edema monitoring may guide postoperative rehabilitation strategies.
运动功能恶化是胶质瘤患者常见的术后并发症，影响日常活动。尽管持续康复对运动恢复至关重要，但术后功能下降的根本原因仍不清楚。本病例研究调查了一名胶质瘤患者在清醒开颅术后运动功能、皮质脊髓束（CST）分数各向异性（FA）和水肿之间的时间关系。一名43岁的日本男性，患有复发性左顶叶胶质瘤和右痉挛性偏瘫，在12年中接受了7次肿瘤切除术，最终进行了清醒开颅手术。他术后出现运动功能下降并接受了持续康复治疗。术前以及术后第12天、第29天和第134天评估了CST的FA值和运动功能。使用磁共振成像（MRI）的T2液体衰减反转恢复（FLAIR）序列监测水肿进展。术后第12天，额顶叶区域出现明显水肿增加，同时FA和运动功能下降。然而，到术后第29天和第134天，水肿减轻，FA和运动功能均有所改善。研究结果表明，血管源性水肿导致了短暂的运动功能下降，可逆的FA变化证明了这一点，这表明通过FA评估CST完整性和监测水肿可能指导术后康复策略。
