Use of Diffusion Weighted Mriin Predicting Early Post-Operative Outcome of a New Neurological Deficit Afterbrain Tumor Resection

Khan, Raja B.; Gutin, Philip H.; Shesh, N.; Zhang, Lijun; Krol, George; DeAngelis, Lisa M.

doi:10.1227/01.neu.0000219218.43128.fc

Cited by 37 publications

(23 citation statements)

References 19 publications

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“…7 As shown in previous studies, ischemic events after glioma resection are common, occur in 31% of resections for newly diagnosed gliomas, and are more frequent (80%) in patients undergoing resection for recurrent gliomas. 6,7,9,21,23,27 These ischemic lesions correlate with a high incidence of neurological deficits. 6,7 Although it is obvious that direct nonvascular damage to motor-eloquent cortical or subcortical brain areas influences intraoperative MEP monitoring, it is still unclear whether intraoperative vascular damage leading to ischemia can cause intraoperative MEP decline or remains undetectable because of delayed tissue damage.…”

mentioning

confidence: 99%

Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

Gempt¹,

Krieg

Hüttinger

et al. 2013

JNS

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Object The aim of surgical glioma treatment is the complete resection of tumor tissue while preserving neurological function. Surgery-related neurological deficits arise from direct damage to the cortical or subcortical structures or from ischemia. The authors aimed to assess the incidence of resection-related ischemia of newly diagnosed or recurrent supratentorial gliomas and the sensitivity of intraoperative neuromonitoring (IOM) of motor evoked potentials (MEPs) for detecting such ischemic events and their influence on neurological motor function. Methods Between January 2009 and December 2010, 70 patients with tumors in motor-eloquent brain areas underwent intraoperative MEP monitoring during glioma resection and were examined by early postoperative MRI including diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping. Postoperative areas of restricted diffusion were assessed by investigators blinded to the course of intraoperative MEPs and the neurological course. Results Among the 70 enrolled patients, a MEP amplitude decline below 50% of the baseline level was observed in 21 patients (30%). Sixteen of these patients (76%) had ischemic lesions identified on postoperative MRI scans. Forty-nine patients (70%) showed no decline in MEP amplitude, and only 16 (33%) of these patients harbored ischemic lesions. Moreover, 9 (69%) of 13 patients with a permanent loss of MEP amplitude showed postoperative ischemic lesions. Factors that promoted the occurrence of postoperative infarction were previous radiotherapy and location of the tumor close to the central arteries. Conclusions Alterations in the MEP amplitude during tumor resection and postoperative ischemic lesions are associated with postoperative impairment of motor function. Rather than cortical or subcortical structural damage of eloquent brain tissue alone, peri- or postoperative ischemic lesions play a crucial role in the development of surgery-related motor deficits.

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confidence: 99%

Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

Gempt¹,

Krieg

Hüttinger

et al. 2013

JNS

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“…The FIM is a rehabilitation measure and does not specifically measure gait, balance, or the specifics of ambulation [23,39,40]. The KPS measures activities of daily living [2]; gait and balance are not considered in scoring. As such, these measures were not appropriate for assessing patient mobility in terms of gait and balance.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have assessed the effectiveness of surgery in minimizing tumor volume, reducing recurrence rates, or increasing survival time following diagnosis [2][3][4][5][6][7]. However, very few studies specifically measure functional outcomes using reliable and valid instruments despite clinical tools to quantify this domain [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Relationship of Balance and Mobility Status to Quality of Life in Patients with Primary Brain Tumors: A Pilot Study

Krug¹,

Litofsky

2014

Int J Phys Med Rehabil

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Objective: Most research regarding the effectiveness of brain tumor treatments measure survival time, recurrence rate, and extent of surgical resection. Objective measurements of functional abilities and self-perceived quality of life (QoL) are important aspects of treatment response, yet these are not commonly assessed. This study was designed to determine the relationship between balance and mobility status and self-perceived QoL for patients before and after surgical excision of primary brain tumors. Methods:Nine adults who underwent surgical excision of presumed primary brain tumor were assessed prior to, immediately following, and 3 months post-surgery utilizing the Timed Up-and-Go (TUG), Tinetti PerformanceOriented Mobility Assessment (Tinetti) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). ANOVA with repeated measures over time was performed on the data across the three time points. Outcome measures were correlated using Spearman's correlations. Statistical significance for all tests was accepted at p < 0.05. Results:Balance, mobility and QoL measures changed significantly from pre-surgery to immediately postsurgery and from immediately post-surgery to 3 months later. However, neither QoL nor balance or mobility demonstrated significant change from pre-surgery to 3 months post-surgery. These results reflect clinically-noted changes in physical abilities the 3 time points. All measures significantly correlated at the two post-surgery measurements, indicating a close link between balance and mobility and QoL. Conclusion:The TUG and Tinetti can be used in brain tumor patients to quantify clinical changes in balance and mobility. These changes correlate with QoL over time.

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“…The presence of DWI changes following brain tumor resections has been well described [24][25][26] . Khan et al [24] in their prospective study of 80 patients showed that 31 (39%) had a thin marginal pericavity bright DWI signal, considered to be a normal postoperative change.…”

Section: Discussionmentioning

confidence: 99%

Report of Negative Diffusion-Weighted MR Imaging during Tumor Resections Using Intraoperative MRI

Prabhu¹,

Levine

Rao³

et al. 2009

Stereotact Funct Neurosurg

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Intraoperative MR imaging allows surgeons to continually assess the extent of resection of a tumor and other potential complications. Diffusion-weighted MR imaging (DWI) is a very important diagnostic tool for the early detection of ischemic injury to the brain. Ischemic changes could potentially result in the development of infarction and neurological deficits during brain tumor resections; however, the incidence and importance of negative DWI is poorly understood. Here, we describe 3 cases of negative DWI during brain tumor resections using BrainSUITE, and discuss the possible causes and outcomes in these patients.

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Use of Diffusion Weighted Mriin Predicting Early Post-Operative Outcome of a New Neurological Deficit Afterbrain Tumor Resection

Abstract: Postoperative diffusion magnetic resonance imaging is useful in predicting early functional recovery from new deficits after brain tumor surgery.

Cited by 37 publications

References 19 publications

Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

Relationship of Balance and Mobility Status to Quality of Life in Patients with Primary Brain Tumors: A Pilot Study

Report of Negative Diffusion-Weighted MR Imaging during Tumor Resections Using Intraoperative MRI

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