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Hotspots of small strokes in glioma surgery: an overlooked risk?

Acta Neurochirurgica volume 161, pages 91–98 (2019)Cite this article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

EM thanks Pr Duffau for fruitful discussions about this work.

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Authors and Affiliations

  1. Université Paris 7 Diderot, Paris, France

    Marie-Pierre Loit, Etienne Gayat, Sébastien Froelich, Nanxi Zhi & Emmanuel Mandonnet

  2. Department of Neurosurgery, Lariboisière Hospital, 2 rue Ambroise Paré, 75010, Paris, France

    Marie-Pierre Loit, François Rheault, Isabelle Poisson, Sébastien Froelich & Emmanuel Mandonnet

  3. Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science Department, Université de Sherbrooke, Sherbrooke, Canada

    François Rheault

  4. Department of Anesthesiology, Lariboisière Hospital, Paris, France

    Etienne Gayat & Nanxi Zhi

  5. Université François-Rabelais de Tours, Inserm, Imagerie et cerveau UMR U930, Tours, France

    Stéphane Velut

  6. Department of Neurosurgery, CHRU de Tours, Tours, France

    Stéphane Velut

  7. Frontlab, INSERM, Institut du Cerveau et de la Moelle (ICM), Paris, France

    Emmanuel Mandonnet

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  1. Marie-Pierre Loit
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Correspondence to Emmanuel Mandonnet.

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The authors declare that they have no conflict of interest.

Informed consent

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.

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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.

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This article is part of the Topical Collection on Tumor - Glioma

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Loit, MP., Rheault, F., Gayat, E. et al. Hotspots of small strokes in glioma surgery: an overlooked risk?. Acta Neurochir 161, 91–98 (2019). https://doi.org/10.1007/s00701-018-3717-3

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  • DOI: https://doi.org/10.1007/s00701-018-3717-3

Keywords

  • Strokes
  • Glioma
  • Surgery
  • Cognitive outcome