Abstract
BackgroundPrevalence, radiological characteristics, and risk factors for peritumoral infarctions after glioma surgery are not much studied. In this study, we assessed shape, volume, and prevalence of peritumoral infarctions and investigated possible associated factors.MethodsIn a prospective single-center cohort study, we included all adult patients operated for diffuse gliomas from January 2007 to December 2018. Postoperative infarctions were segmented using early postoperative MRI images, and volume, shape, and location of postoperative infarctions were assessed. Heatmaps of the distribution of tumors and infarctions were created.ResultsMRIs from 238 (44%) of 539 operations showed restricted diffusion in relation to the operation cavity, interpreted as postoperative infarctions. Of these, 86 (36%) were rim-shaped, 103 (43%) were sector-shaped, 40 (17%) were a combination of rim- and sector-shaped, and six (3%) were remote infarctions. Median infarction volume was 1.7 cm3 (IQR 0.7–4.3, range 0.1–67.1). Infarctions were more common if the tumor was in the temporal lobe, and the map shows more infarctions in the periventricular watershed areas. Sector-shaped infarctions were more often seen in patients with known cerebrovascular disease (47.6% vs. 25.5%, p = 0.024). There was a positive correlation between infarction volume and tumor volume (r = 0.267, p < 0.001) and infarction volume and perioperative bleeding (r = 0.176, p = 0.014). Moreover, there was a significant positive association between age and larger infarction volumes (r = 0.193, p = 0.003). Infarction rates and infarction volumes varied across individual surgeons, p = 0.037 (range 32–72%) and p = 0.026.ConclusionsIn the present study, peritumoral infarctions occurred in 44% after diffuse glioma operations. Infarctions were more common in patients operated for tumors in the temporal lobe but were not more common following recurrent surgeries. Sector-shaped infarctions were more common in patients with known cerebrovascular disease. Increasing age, larger tumors, and more perioperative bleeding were factors associated with infarction volumes. The risk of infarctions and infarction volumes may also be surgeon-dependent.
Highlights
The prognosis of diffuse glioma improves with extent of surgical resection [19, 16, 20], but glioma surgery is a balance between extensive tumor resections and avoiding damage to adjacent functional brain tissue
Restricted diffusion in postoperative magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) scans interpreted as infarctions were found in 238 (44%) of the 539 operations, while 301 of 539 (56%) of the postoperative MRI scans had no significant DWI signal changes
Peritumoral infarctions were more common in patients operated for tumors in the temporal lobe
Summary
The prognosis of diffuse glioma improves with extent of surgical resection [19, 16, 20], but glioma surgery is a balance between extensive tumor resections and avoiding damage to adjacent functional brain tissue. Extended author information available on the last page of the article diffusion-weighted imaging (DWI), it has been reported that perioperative and mostly peritumoral infarctions occur in 19–80% of patients undergoing tumor surgery. These infarctions have been associated with postoperative neurological deficits and impaired function [8, 9, 17, 21, 15]. We assessed shape, volume, and prevalence of peritumoral infarctions and investigated possible associated factors. Increasing age, larger tumors, and more perioperative bleeding were factors associated with infarction volumes. The risk of infarctions and infarction volumes may be surgeon-dependent
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