• Neurosurgery · Feb 2017

    The Impact of Intracranial Tumor Proximity to White Matter Tracts on Morbidity and Mortality: A Retrospective Diffusion Tensor Imaging Study.

    • Erin J Meyer, Wolfgang Gaggl, Benjamin Gilloon, Benjamin Swan, Max Greenstein, Jed Voss, Namath Hussain, Ryan L Holdsworth, Veena A Nair, M Elizabeth Meyerand, John S Kuo, Mustafa K Baskaya, Aaron S Field, and Vivek Prabhakaran.
    • Departments of Radiology, Case Western Reserve Medical School Cleveland, Ohio, USA.
    • Neurosurgery. 2017 Feb 1; 80 (2): 193-200.

    BackgroundUsing diffusion tensor imaging (DTI) in neurosurgical planning allows identification of white matter tracts and has been associated with a reduction in postoperative functional deficits.ObjectiveThis study explores the relationship between the lesion-to-tract distance (LTD) and postoperative morbidity and mortality in patients with brain tumors in order to evaluate the role of DTI in predicting postoperative outcomes.MethodsAdult patients with brain tumors (n = 60) underwent preoperative DTI. Three major white matter pathways (superior longitudinal fasciculi [SLF], cingulum, and corticospinal tract) were identified using DTI images, and the shortest LTD was measured for each tract. Postoperative morbidity and mortality information was collected from electronic medical records.ResultsThe ipsilesional corticospinal tract LTD and left SLF LTD were significantly associated with the occurrence rate of total postoperative motor (P = .018) and language (P < .001) deficits, respectively. The left SLF LTD was also significantly associated with the occurrence rate of new postoperative language deficits (P = .003), and the LTD threshold that best predicted this occurrence was 1 cm (P < .001). Kaplan–Meier log-rank survival analyses in patients having high-grade tumors demonstrated a significantly higher mortality for patients with a left SLF LTD <1 cm (P = .01).ConclusionMeasuring tumor proximity to major white matter tracts using DTI can inform clinicians of the likelihood of postoperative functional deficits. A distance of 1 cm or less from eloquent white matter structures most significantly predicts the occurrence of new deficits with current surgical and imaging techniques.Copyright © 2016 by the Congress of Neurological Surgeons

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