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The efficacy of preoperative diffusion tensor tractography on surgical planning and outcomes in patients with intramedullary spinal tumor

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Abstract

Purpose

The aim of this study was to investigate the efficacy of diffusion tensor tractography (DTT) of spinal cord on surgical planning and postoperative neurological outcomes in patients with spinal intramedullary tumors.

Methods

The study was conducted retrospectively from the radiological and clinical data of our hospital database. Patients with intramedullary spinal cord tumors who underwent diffusion tensor imaging for spinal cord lesions were selected between 2019 and 2022. Demographic characteristics and intraoperative neurophysiological monitoring data were evaluated. The McCormick scale was used to grade the pre- and postoperative neurological status of the patients. The tumoral lesions were categorized into 3 types according to the fiber course on DTT.

Results

Eleven patients were found to have radiological findings that were compatible with intramedullary tumor; eight (72.7%) of them ultimately underwent surgery following being approved as surgical candidates in the spinal diffusion tensor imaging studies. Six cases had Type 1, one case had Type 2, and 4 cases had Type 3 tumors according to the fiber course. All Type 1 tumors were classified as resectable and all of them were gross totally resected. Type 2 lesion that was rated as resectable by DTI was subtotally resected. Type 3 lesions were followed without surgery except the one with tumoral progression and neurological deficit. The postoperative neurological outcomes were compatible with intraoperative neurophysiological monitoring results.

Conclusion

Diffusion tensor imaging and tractography may be beneficial regarding the selection of patients suitable for surgery and in the subsequent surgical planning.

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References

  1. Nanda G, Jain P, Suman A, Mahajan H (2022) Role of diffusion tensor imaging and tractography in spinal cord injury. J Clin Orthop Trauma 33:101997

    Article  PubMed  PubMed Central  Google Scholar 

  2. Safri AA, Nassir C, Iman IN, Mohd Taib NH, Achuthan A, Mustapha M (2022) Diffusion tensor imaging pipeline measures of cerebral white matter integrity: an overview of recent advances and prospects. World J Clin Cases 10(24):8450–8462

    Article  PubMed  PubMed Central  Google Scholar 

  3. Andre JB, Bammer R (2010) Advanced diffusion-weighted magnetic resonance imaging techniques of the human spinal cord. Top Magn Reson Imaging 21(6):367–378

    Article  PubMed  PubMed Central  Google Scholar 

  4. Costanzo R, Brunasso L, Paolini F, Benigno UE, Porzio M, Giammalva GR, Gerardi RM, Umana GE, di Bonaventura R, Sturiale CL et al (2022) Spinal tractography as a potential prognostic tool in spinal cord injury: a systematic review. World Neurosurg 164:25–32

    Article  PubMed  Google Scholar 

  5. Fujiyoshi K, Konomi T, Yamada M, Hikishima K, Tsuji O, Komaki Y, Momoshima S, Toyama Y, Nakamura M, Okano H (2013) Diffusion tensor imaging and tractography of the spinal cord: from experimental studies to clinical application. Exp Neurol 242:74–82

    Article  PubMed  Google Scholar 

  6. Dauleac C, Frindel C, Mertens P, Jacquesson T, Cotton F (2020) Overcoming challenges of the human spinal cord tractography for routine clinical use: a review. Neuroradiology 62(9):1079–1094

    Article  PubMed  Google Scholar 

  7. Hendrix P, Griessenauer CJ, Cohen-Adad J, Rajasekaran S, Cauley KA, Shoja MM, Pezeshk P, Tubbs RS (2015) Spinal diffusion tensor imaging: a comprehensive review with emphasis on spinal cord anatomy and clinical applications. Clin Anat 28(1):88–95

    Article  PubMed  Google Scholar 

  8. Li DC, Malcolm JG, Rindler RS, Baum GR, Rao A, Khurpad SN, Ahmad FU (2017) The role of diffusion tensor imaging in spinal pathology: a review. Neurol India 65(5):982–992

    Article  PubMed  Google Scholar 

  9. Hirano K, Imagama S, Sato K, Kato F, Yukawa Y, Yoshihara H, Kamiya M, Deguchi M, Kanemura T, Matsubara Y et al (2012) Primary spinal cord tumors: review of 678 surgically treated patients in Japan. A multicenter study Eur Spine J 21(10):2019–2026

    Article  PubMed  Google Scholar 

  10. Samartzis D, Gillis CC, Shih P, O’Toole JE, Fessler RG (2015) Intramedullary spinal cord tumors: part I-epidemiology, pathophysiology, and diagnosis. Global Spine J 5(5):425–435

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tihan T, Chi JH, McCormick PC, Ames CP, Parsa AT (2006) Pathologic and epidemiologic findings of intramedullary spinal cord tumors. Neurosurg Clin N Am 17(1):7–11

    Article  PubMed  Google Scholar 

  12. Setzer M, Murtagh RD, Murtagh FR, Eleraky M, Jain S, Marquardt G, Seifert V, Vrionis FD (2010) Diffusion tensor imaging tractography in patients with intramedullary tumors: comparison with intraoperative findings and value for prediction of tumor resectability. J Neurosurg Spine 13(3):371–380

    Article  PubMed  Google Scholar 

  13. Shigematsu H, Ando M, Kobayashi K, Yoshida G, Funaba M, Morito S, Takahashi M, Ushirozako H, Kawabata S, Yamada K et al (2022) Efficacy of D-wave monitoring combined with the transcranial motor-evoked potentials in high-risk spinal surgery: a retrospective multicenter study of the monitoring committee of the japanese society for spine surgery and related research. Global Spine J. https://doi.org/10.1177/21925682221084649

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sala F, Palandri G, Basso E, Lanteri P, Deletis V, Faccioli F, Bricolo A (2006) Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study. Neurosurgery 58(6):1129–1143

    Article  PubMed  Google Scholar 

  15. Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G (2005) Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery 56(5):972–981

    PubMed  Google Scholar 

  16. Nakamura M, Ishii K, Watanabe K, Tsuji T, Takaishi H, Matsumoto M, Toyama Y, Chiba K (2008) Surgical treatment of intramedullary spinal cord tumors: prognosis and complications. Spinal Cord 46(4):282–286

    Article  CAS  PubMed  Google Scholar 

  17. Ducreux D, Lepeintre JF, Fillard P, Loureiro C, Tadié M, Lasjaunias P (2006) MR diffusion tensor imaging and fiber tracking in 5 spinal cord astrocytomas. AJNR Am J Neuroradiol 27(1):214–216

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Hohenhaus M, Merz Y, Klingler J-H, Scholz C, Hubbe U, Beck J, Wolf K, Egger K, Reisert M, Kremers N (2022) Diffusion tensor imaging in unclear intramedullary tumor-suspected lesions allows separating tumors from inflammation. Spinal Cord 60(7):655–663

    Article  PubMed  Google Scholar 

  19. Vargas MI, Delavelle J, Jlassi H, Rilliet B, Viallon M, Becker CD, Lövblad KO (2008) Clinical applications of diffusion tensor tractography of the spinal cord. Neuroradiology 50(1):25–29

    Article  PubMed  Google Scholar 

  20. Tsuchiya K, Fujikawa A, Honya K, Nitatori T, Suzuki Y (2008) Diffusion tensor tractography of the lower spinal cord. Neuroradiology 50(3):221–225

    Article  PubMed  Google Scholar 

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Radiology, Division of Neuroradiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey

    Bora Korkmazer, Serdar Arslan & Osman Kizilkilic

  2. Department of Neurosurgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey

    Rahsan Kemerdere, Gulcin Bas & Mehmet Murat Hanci

  3. Department of Radiology, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Turkey

    Bilal Demir & Abdulmelik Batkitar

Authors
  1. Bora Korkmazer
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  2. Rahsan Kemerdere
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  3. Gulcin Bas
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  4. Serdar Arslan
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  5. Bilal Demir
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  7. Osman Kizilkilic
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  8. Mehmet Murat Hanci
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Correspondence to Bora Korkmazer.

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The authors declare no conflict of interests.

Ethics approval

Ethical approval was waived by the local ethics committee of the university, in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.

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Korkmazer, B., Kemerdere, R., Bas, G. et al. The efficacy of preoperative diffusion tensor tractography on surgical planning and outcomes in patients with intramedullary spinal tumor. Eur Spine J 32, 4321–4327 (2023). https://doi.org/10.1007/s00586-023-07872-5

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  • DOI: https://doi.org/10.1007/s00586-023-07872-5

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