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Quantitative MRI Tractography of White Matter Tracts After Tumor Craniotomy Surgery: Comparative Analysis Between
Cynthia Alms1,2, Chikezie I Eseonu1,3
1Neurological Surgery, University of Pittsburgh Medical Center (UPMC) Central Pennsylvania, Harrisburg , Pennsylvania , USA.
Background And Objectives:
Tubular retraction has been a technique used to minimize the extent of cerebral retraction injury; however, only qualitative imaging assessments exist in the literature comparing this technique with open craniotomies using spatula retraction. This study uses quantitative MRI tractography to analyze the extent of cerebral retraction injury using tubular retraction (TR) compared with open craniotomies (OC).
Methods:
This study performed a retrospective analysis of a cohort of 20 patients who underwent cranial tumor surgery for deep-seated brain tumors. Ten patients who underwent surgery with TR were case-control matched with 10 patients who underwent an OC with spatula retraction. Quantitative metrics evaluating white matter tract integrity (fractional anisotropy (FA), geodesic anisotropy (GA), mean diffusivity, radial diffusivity, axial diffusivity, and tract volume), extent of resection, and neurological outcome were compared between the groups.
Results:
Twenty patients underwent cranial surgery for deep-seated brain lesions. Preoperative neurological and tumor characteristics were comparable between the 2 cohorts. Postoperative extent of resection was found to be 90.4% in the TR group and 94.8% in the OC group ( P = .395). Significant improvement was seen in the change in Karnofsky Performance Score from preoperative to postoperative status in the TR group, an 11-point increase, compared with the OC group, no change in score ( P = .035). Quantitative metrics evaluating overall axonal status (FA) and compression (GA) showed significant signs of improvement in the TR group, with an FA of 0.322 vs 0.029 in the OC group ( P = .011). GA was found to increase in the TR group (0.441) and decrease in the OC group (0.411, P = .0.012). Diffusivity metrics, evaluating axonal integrity were comparable between the 2 groups.
Conclusion:
Tubular retraction surgery provides a viable surgical option for deep-seated tumors that provides comparable extent of resection outcomes while mitigating the effects of some components of retraction injury.
Insights
Tubular retraction (TR) surgery for deep-seated brain tumors shows improved patient outcomes and reduced injury compared to open craniotomies (OC). This technique offers a viable surgical option with comparable resection rates and better neurological function.
Area of Science:
- Neurosurgery
- Neuroimaging
- Brain Tumor Surgery
Background:
- Cerebral retraction injury is a concern in deep-seated brain tumor surgery.
- Tubular retraction (TR) is a technique to minimize this injury.
- Quantitative MRI tractography has not been previously used to compare TR with open craniotomies (OC).
Purpose of the Study:
- To quantitatively compare the extent of cerebral retraction injury between tubular retraction (TR) and open craniotomies (OC) using MRI tractography.
- To evaluate white matter tract integrity, extent of resection, and neurological outcomes.
Main Methods:
- Retrospective analysis of 20 patients with deep-seated brain tumors.
- Case-control matching of 10 patients undergoing TR with 10 patients undergoing OC.
- Quantitative MRI metrics (FA, GA, diffusivity, tract volume) and neurological scores (Karnofsky Performance Score) were compared.
Main Results:
- No significant difference in the extent of resection between TR (90.4%) and OC (94.8%).
- Significant improvement in Karnofsky Performance Score in the TR group (11-point increase) vs. no change in the OC group.
- Improved axonal status (FA) and reduced compression (GA) in the TR group compared to OC.
Conclusions:
- Tubular retraction surgery is a viable option for deep-seated tumors.
- TR provides comparable extent of resection outcomes to OC.
- TR mitigates some components of retraction injury, leading to better neurological outcomes.
