• Md Tauseef Khalid, John Carson Allen, King Nicolas Kon Kam NKK National Neuroscience Institute, Department of Neurosurgery, Singapore City, Singapore., Jai Prashanth Rao, Eddie Tung Wee Tan, See Angela An Qi AAQ National Neuroscience Institute, Department of Neurosurgery, Singapore City, Singapore., Rajesh Moorakonda, and Wai Hoe Ng.
• Duke NUS Medical School, Singapore City, Singapore. Electronic address: md.tauseef.khalid@mohh.com.sg.
• World Neurosurg. 2017 Nov 1; 107: 612-622.

ObjectiveThis study aimed to characterize pyramidal tract shift in different regions of the brain during glioma resection and its association with head position and tumor location.MethodsFrom 2008-2013, 14 patients presenting at the National Neuroscience Institute with high-grade glioma (World Health Organization III or IV) underwent preoperative and intraoperative diffusion tensor imaging. A novel method of placing landmarks along the preoperative and intraoperative tracts, with anterior commissure as the origin, was used to determine pyramidal tract shift. Shift was evaluated in x (lateromedial), y (anteroposterior), and z (craniocaudal) directions for 3 brain regions: brainstem, around third and lateral ventricles, and above ventricles. Shift radius is calculated as the distance between preoperative and postoperative landmarks.ResultsMean shift radius was 2.72 ± 0.55, 2.98 ± 0.53, and 4.04 ± 0.58 mm at the brainstem, third and lateral ventricles, and above the ventricles, respectively (P < 0.001). Only shift in the y direction (P < 0.03) and shift radius (P < 0.03) were significantly different among regions. Head position during surgery strongly influenced shift radius above the ventricles (P < 0.005), but tumor location had no significant effect. The z-direction shift did not differ significantly among regions.ConclusionDirection of pyramidal tract shift in 3 dimensions is unpredictable; hence shift radius is a more clinical useful concept. Shift radius was largest above the ventricles and was strongly influenced by head position, with a trend for temporal lobe tumors to exhibit larger shifts.Copyright © 2017 Elsevier Inc. All rights reserved.

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