Resectability of White Matter Tracts in Patients With Language-Critical Gliomas

Area of Science:

• Neurosurgery
• Neuroscience
• Oncology

Background:

• Maximal safe resection is crucial for language-eloquent gliomas.
• White matter tracts (WMTs) provide insights into surgical decision-making.
• The resectability of specific WMTs and their relation to language deficits is not fully understood.

Purpose of the Study:

• To identify predictors of permanent postoperative language deficits (PLDs) after glioma resection.
• To evaluate the functional relevance of specific white matter segments.
• To determine the resectability of language-associated WMTs.

Main Methods:

• Retrospective cohort study of 78 glioma patients.
• WMT reconstructions for 6 language-associated tracts.
• Calculation of positive predictive value (PPV) for tract segments and normalization to MNI space.

Main Results:

• WMT resection strongly predicted PLDs (OR=16.00, P=.0115) with high NPV (97.4%) but low PPV (29.6%).
• Resected tract segments (RTS) associated with PLDs clustered in the temporoparietal junction and middle temporal lobe.
• Frontal lobe WMTs showed near-complete resectability (PPV=0), while parietal and temporal WMTs had significantly lower resectability (PPV=0.4-1.0).

Conclusions:

• WMT resection is a robust predictor of PLDs.
• WMTs in the orbitofrontal region, anterior temporal lobe, and frontal operculum are resectable.
• Parietal and temporal WMT resections significantly increase the risk of PLDs.