Introduction: Diffusion tensor (DTI) and functional magnetic resonance (fMRI) imaging are used to guide the resection of intracranial neoplasms. Neurologic morbidity of any severity ranges 20-41%, with major morbidity and perioperative mortality as low as 12% and 1.7%, respectively. Here, we quantify post-operative outcomes with DTI and fMRI pre-surgical brain mapping.
Methods: We reviewed medical records of all patients undergoing fMRI and DTI for pre-surgical planning over 54-months at a single academic tertiary referral center. Of these, patients undergoing resection of a supratentorial neoplasm by a single surgeon with complete neurologic/neurosurgical follow-up were included. Demographic, operative, and pre- and post-operative documentation was reviewed to assess post-operative morbidity and mortality. Response of pre-operative neurologic deficits at immediate, 1-week, 1-month, and 6-months post-operatively was determined. This study received IRB approval.
Results: In total, 76 patients underwent pre-surgical DTI/fMRI brain mapping prior to resection for 69 primary and 7 metastatic lesions. 61% were primary operations. Over 80% were for high-grade (WHO-III, -IV, or metastatic) lesions. Of patients with pre-operative neurological deficits (N=67), 53% demonstrated improvement post-operatively while 5% demonstrated worsened symptoms. Post-operatively, 21 patients experienced new post-operative neurologic morbidity; 90.5% occurred in high-grade neoplasms and 48% resolved by 6-months post-operatively. Four patients (5%) experienced major morbidities: 2 cases of meningitis, a stroke, and one episode of severe hemiparesis. There was one perioperative mortality at 22 days; six-month mortality was 14%, all in patients with high-grade lesions. Mean post-operative length of stay was 4 ± 2 days and 76% of patients were discharged home.
Conclusions: We demonstrate improved major morbidity and mortality rates compared to previous studies in one of the largest clinical series to date. Our study reiterates the benefit of DTI and fMRI in pre-surgical planning for resection of supratentorial tumors and the need for further prospective validation of this promising technology.
Patient Care: The use of fMRI and DTI for multi-parameter, multi-layer presurgical brain mapping in neurosurgical supratentorial tumor patients is not routine. Establishing postsurgical neurological outcomes in patients undergoing preoperative brain mapping by these techniques is a necessary step in quality assurance of new technology utilization. Compared to the best reported rates in the literature, our single-surgeon series demonstrates even further improved morbidity and mortality rates. Our results suggest fMRI/DTI multi-parameter, multi-layer preoperative brain mapping may provide even greater morbidity and mortality benefit than previously reported. These findings further support the need for a well-designed prospective trial comparing outcomes in patients undergoing supratentorial tumor resection both with and without the preoperative use of this technology.
Learning Objectives: By the conclusion of this session, participants should be able to: (1) Describe data from modern series on the incidence of neurosurgical morbidity and mortality in patients undergoing resection of supratentorial tumors in modern series both with and without the use of fMRI/DTI presurgical brain mapping. (2) Discuss and critically evaluate, in small groups, results of this single-institution case series in the context of previous modern series and potential future prospective studies to further validate this technique. (3) Identify patients in whom fMRI/DTI pre-surgical mapping may be of particular benefit in predicting postoperative morbidity and mortality.