Hotspots of small strokes in glioma surgery: an overlooked risk?
- 11 Downloads
Small deep infarcts constitute a well-known risk of motor and speech deficit in insulo-opercular glioma surgery. However, the risk of cognitive deterioration in relation to stroke occurrence in so-called silent areas is poorly known. In this paper, we propose to build a distribution map of small deep infarcts in glioma surgery, and to analyze patients’ cognitive outcome in relation to stroke occurrence.
We retrospectively studied a consecutive series of patients operated on for a diffuse glioma between June 2011and June 2017. Patients with lower-grade glioma were cognitively assessed, both before and 4 months after surgery. Areas of decreased apparent diffusion coefficient (ADC) on the immediate postoperative MRI were segmented. All images were registered in the MNI reference by ANTS algorithm, allowing to build a distribution map of the strokes. Stroke occurrence was correlated with the postoperative changes in semantic fluency score in the lower-grade glioma cohort.
One hundred fifteen patients were included. Areas of reduced ADC were observed in 27 out of 54 (50%) patients with a lower-grade glioma, and 25 out of 61 (41%) patients with a glioblastoma. Median volume was 1.6 cc. The distribution map revealed five clusters of deep strokes, corresponding respectively to callosal, prefrontal, insulo-opercular, parietal, and temporal tumor locations. No motor nor speech long-term deficits were caused by these strokes. Cognitive evaluations at 4 months showed that the presence of small infarcts correlated with a slight decrease of semantic fluency scores.
Deep small infarcts are commonly found after glioma surgery, but their actual impact in terms of patients’ quality of life remains to be demonstrated. Further studies are needed to better evaluate the cognitive consequences—if any—for each of the described hotspots and to identify risk factors other than the surgery-induced damage of microvessels.
KeywordsStrokes Glioma Surgery Cognitive outcome
EM thanks Pr Duffau for fruitful discussions about this work.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All patients signed a written informed consent for retrospective analysis of their clinical and radiological data, although due to the retrospective nature of the study, formal consent is not required.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 4.Szelényi A, Bello L, Duffau H, Fava E, Feigl GC, Galanda M, Neuloh G, Signorelli F, Sala F, Workgroup for Intraoperative Management in Low-Grade Glioma Surgery within the European Low-Grade Glioma Network (2010) Intraoperative electrical stimulation in awake craniotomy: methodological aspects of current practice. Neurosurg Focus 28(2):E7CrossRefGoogle Scholar
- 8.Rheault F, Houde J, Goyette N, Morency F, Descoteaux M (2016) MI-Brain, a software to handle tractograms and perform interactive virtual dissection. In: Proceeding of: Breaking the Barriers of Diffusion MRI (ISMRM workshop). September. Lisbon, Portugal, 2016 Google Scholar
- 12.Foulon C, Cerliani L, Kinkingnéhun S, Levy R, Rosso C, Urbanski M, Volle E, Thiebaut de Schotten M (2018) Advanced lesion symptom mapping analyses and implementation as BCBtoolkit. Gigascience. https://doi.org/10.1093/gigascience/giy004
- 13.Mandonnet E, Wager M, Almairac F et al (2017) Survey on current practice within the European low-grade glioma network: where do we stand and what is the next step? Neurooncol Pract. https://doi.org/10.1093/nop/npw031
- 17.Jakola AS, Berntsen EM, Christensen P, Gulati S, Unsgård G, Kvistad KA, Solheim O (2014) Surgically acquired deficits and diffusion weighted MRI changes after glioma resection - a matched case-control study with blinded neuroradiological assessment. PLoS One 9(7):e101805. https://doi.org/10.1371/journal.pone.0101805 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Gempt J, Krieg SM, Hüttinger S, Buchmann N, Ryang Y-M, Shiban E, Meyer B, Zimmer C, Förschler A, Ringel F (2013) Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials. J Neurosurg 119(4):829–836CrossRefGoogle Scholar