The application value of diffusion tensor imaging in surgical management of patients with brainstem gliomas

Abstract

Objective To explore the role of diffusion tensor imaging (DTI) in brainstem glioma surgery. Methods A retrospective analysis was performed on 57 patients with brainstem gliomas who had undertaken surgery from January 2014 to December 2018 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University. All patients underwent preoperative DTI and tumor resection with the assistance of neuronavigation and electrophysiological monitoring. Radiological and clinical data were collected, including conventional MRI and DTI, corticospinal tract (CST) score, tumor-to-CST distance (TCD), muscle strength and Karnofsky performance status (KPS) before and after surgery. Kruskal-Wallis H test was used to evaluate postoperative motor deficit and KPS of patients with different CST scores. Spearman's correlation was performed to assess the relationship of both CST score and TCD with postoperative motor deficits and KPS, respectively. Multiple linear regression was used to investigate the influence of CST score and TCD on postoperative muscle strength and KPS. Results Among the 57 patients, 51 patients had at least one CST compromised. The most common changes of the CST were deviation (30/114, 26.3%) and deformation (30/114, 26.3%). The surgical approaches were adjusted after evaluation of the DTI results in 21 (36.8%) cases. Postoperative muscle strength and KPS were significantly different between different CST score groups (χ2=16.011; χ2=9.576, all P<0.05). Preoperative CST scores were negatively correlated with postoperative muscle strength and KPS (r=-0.362; r=-0.354, both P<0.05) whereas TCD had positive correlation with both postoperative muscle strength and KPS (r=0.305, r=0.339, both P<0.05). CST score could independently influence postoperative muscle strength (t=-2.438, P=0.016). However, CST score could not independently influence postoperative KPS (t=-0.523, P=0.603). Conclusion DTI plays an important role in surgical management of brainstem gliomas and could help optimize the surgical strategy and predict postoperative motor deficits. Key words: Diffusion tensor imaging; Brainstem glioma; Neurosurgical procedures; Application value