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  • Advanced Fiber Tracking Method Differentiates Cingulate Versus Para-Cingulate Tumors

    Final Number:

    David Tiago Fernandes MD; Sukhdeep S Jhawar MCh; Hamid Borghei-Razavi MD, PhD; Ana C Igami Nakassa MD; Emrah Celtikci MD; Pinar Celtikci MD; Juan Carlos Fernandez-Miranda MD

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: The cingulum bundle is thought to be related with high-order cognitive function and emotional regulation. Tumors involving the cingulate gyrus are uncommon and surgically challenging. They may infiltrate the cingulum as their site of origin, or they may displace it when they arise from paracingulate areas, in which case the cingulum may be preserved. The objective of this report is to apply dMRI to evaluate the integrity of the cingulum to differentiate cingulate from para-cingulate tumors.

    Methods: Retrospective evaluation of our dMRI fiber tracking database was conducted to identify patients with tumors involving the cingulum. Lesions infiltrating and/or disrupting the cingulum bundle were subclassified as primary cingulate tumors and those lesions purely displacing the cingulum were subclassified as para-cingulate tumors. Surgical technique and results were retrospectively evaluated for each subgroup.

    Results: Eleven patients with cingulate / para-cingulate tumors were identified. Pre-operative dMRI fiber tracking showed 4 (36.4%) tumors purely displacing the cingulum and 7 (63.6%) infiltrating and/or disrupting it. Ten patients underwent surgical resection and 1 underwent biopsy only. Surgical approaches included anterior and posterior interhemispheric, and transcortical. For primary cingulate tumors, we performed complete resection of the involved segment of the cingulum in five out of 6 cases (83.33%) while 1 had a subtotal resection. All four patients classified as paracingulate tumors underwent preservation of the cingulum, but achieving gross total resection in 3 and sub-total resection in 1, due to motor positive stimulation during resection. One (10%) patient had postoperative transient aphasia and right-sided hemiparesis, and nine (90%) had an uneventful postoperative period with improvement of their preoperative symptoms.

    Conclusions: Advanced dMRI fiber tracking for surgical planning of cingulate tumors may allow cingulum bundle preservation in selected cases with maximal tumor resection and minimal rate of new post-operative deficits.

    Patient Care: Preoperative planning of tumor affecting the cingulum using an advanced diffusion MRI fiber tracking technique may decrease postoperative complications, improve functional outcome after resection. This may translate in a shorter hospital stay, faster postoperative recovery, and decrease in health cost.

    Learning Objectives: 1. Describe the different types of tumor involvement in the cingulate gyrus. 2. Describe the applications of an advanced dMRI fiber tracking method in the pre-operative evaluation of tumor affecting the cingulum. 3. Define possible benefits in patient outcome when using dMRI fiber tracking in preoperative planning comparing results from the previous series using regular imaging methods. 4. Describe further directions on the surgery of tumor involving the cingulate gyrus.

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