Predicting the Extent of Resection of Motor-Eloquent Gliomas Based on TMS-Guided Fiber Tracking

Background: Surgical planning with nTMS-based tractography is proven to increase safety during surgery. A preoperative risk stratification model has been published based on the M1 infiltration, RMT ratio, and tumor to corticospinal tract distance (TTD). The correlation of TTD with corticospinal trac...

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Autores principales:	Francesco Belotti, Mehmet Salih Tuncer, Tizian Rosenstock, Meltem Ivren, Peter Vajkoczy, Thomas Picht
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	nTMS fiber tracking glioma extent of resection outcome Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/6878826de75d44e1a1928167cc841192
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spelling	oai:doaj.org-article:6878826de75d44e1a1928167cc8411922021-11-25T16:58:51ZPredicting the Extent of Resection of Motor-Eloquent Gliomas Based on TMS-Guided Fiber Tracking10.3390/brainsci111115172076-3425https://doaj.org/article/6878826de75d44e1a1928167cc8411922021-11-01T00:00:00Zhttps://www.mdpi.com/2076-3425/11/11/1517https://doaj.org/toc/2076-3425Background: Surgical planning with nTMS-based tractography is proven to increase safety during surgery. A preoperative risk stratification model has been published based on the M1 infiltration, RMT ratio, and tumor to corticospinal tract distance (TTD). The correlation of TTD with corticospinal tract to resection cavity distance (TRD) and outcome is needed to further evaluate the validity of the model. Aim of the study: To use the postop MRI-derived resection cavity to measure how closely the resection cavity approximated the preoperatively calculated corticospinal tract (CST) and how this correlates with the risk model and the outcome. Methods: We included 183 patients who underwent nTMS-based DTI and surgical resection for presumed motor-eloquent gliomas. TTD, TRD, and motor outcome were recorded and tested for correlations. The intraoperative monitoring documentation was available for a subgroup of 48 patients, whose responses were correlated to TTD and TRD. Results: As expected, TTD and TRD showed a good correlation (Spearman’s ρ = 0.67, <i>p</i> < 0.001). Both the TTD and the TRD correlated significantly with the motor outcome at three months (Kendall’s Tau-b 0.24 for TTD, 0.31 for TRD, <i>p</i> < 0.001). Interestingly, the TTD and TRD correlated only slightly with residual tumor volume, and only after correction for outliers related to termination of resection due to intraoperative monitoring events or the proximity of other eloquent structures (TTD ρ = 0.32, <i>p</i> < 0.001; TRD ρ = 0.19, <i>p</i> = 0.01). This reflects the fact that intraoperative monitoring (IOM) phenomena do not always correlate with preoperative structural analysis, and that additional factors influence the intraoperative decision to abort resection, such as the adjacency of other vulnerable structures. The TTD was also significantly correlated with variations in motor evoked potential (MEP) responses (no/reversible decrease vs. irreversible decrease; <i>p</i> = 0.03). Conclusions: The TTD approximates the TRD well, confirming the best predictive parameter and giving strength to the nTMS-based risk stratification model. Our analysis of TRD supports the use of the nTMS-based TTD measurement to estimate the resection preoperatively, also confirming the 8 mm cutoff. Nevertheless, the TRD proved to have a slightly stronger correlation with the outcome as the surgeon’s experience, anatomofunctional knowledge, and MEP observations influence the expected EOR.Francesco BelottiMehmet Salih TuncerTizian RosenstockMeltem IvrenPeter VajkoczyThomas PichtMDPI AGarticlenTMSfiber trackinggliomaextent of resectionoutcomeNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENBrain Sciences, Vol 11, Iss 1517, p 1517 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	nTMS fiber tracking glioma extent of resection outcome Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	nTMS fiber tracking glioma extent of resection outcome Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Francesco Belotti Mehmet Salih Tuncer Tizian Rosenstock Meltem Ivren Peter Vajkoczy Thomas Picht Predicting the Extent of Resection of Motor-Eloquent Gliomas Based on TMS-Guided Fiber Tracking
description	Background: Surgical planning with nTMS-based tractography is proven to increase safety during surgery. A preoperative risk stratification model has been published based on the M1 infiltration, RMT ratio, and tumor to corticospinal tract distance (TTD). The correlation of TTD with corticospinal tract to resection cavity distance (TRD) and outcome is needed to further evaluate the validity of the model. Aim of the study: To use the postop MRI-derived resection cavity to measure how closely the resection cavity approximated the preoperatively calculated corticospinal tract (CST) and how this correlates with the risk model and the outcome. Methods: We included 183 patients who underwent nTMS-based DTI and surgical resection for presumed motor-eloquent gliomas. TTD, TRD, and motor outcome were recorded and tested for correlations. The intraoperative monitoring documentation was available for a subgroup of 48 patients, whose responses were correlated to TTD and TRD. Results: As expected, TTD and TRD showed a good correlation (Spearman’s ρ = 0.67, <i>p</i> < 0.001). Both the TTD and the TRD correlated significantly with the motor outcome at three months (Kendall’s Tau-b 0.24 for TTD, 0.31 for TRD, <i>p</i> < 0.001). Interestingly, the TTD and TRD correlated only slightly with residual tumor volume, and only after correction for outliers related to termination of resection due to intraoperative monitoring events or the proximity of other eloquent structures (TTD ρ = 0.32, <i>p</i> < 0.001; TRD ρ = 0.19, <i>p</i> = 0.01). This reflects the fact that intraoperative monitoring (IOM) phenomena do not always correlate with preoperative structural analysis, and that additional factors influence the intraoperative decision to abort resection, such as the adjacency of other vulnerable structures. The TTD was also significantly correlated with variations in motor evoked potential (MEP) responses (no/reversible decrease vs. irreversible decrease; <i>p</i> = 0.03). Conclusions: The TTD approximates the TRD well, confirming the best predictive parameter and giving strength to the nTMS-based risk stratification model. Our analysis of TRD supports the use of the nTMS-based TTD measurement to estimate the resection preoperatively, also confirming the 8 mm cutoff. Nevertheless, the TRD proved to have a slightly stronger correlation with the outcome as the surgeon’s experience, anatomofunctional knowledge, and MEP observations influence the expected EOR.
format	article
author	Francesco Belotti Mehmet Salih Tuncer Tizian Rosenstock Meltem Ivren Peter Vajkoczy Thomas Picht
author_facet	Francesco Belotti Mehmet Salih Tuncer Tizian Rosenstock Meltem Ivren Peter Vajkoczy Thomas Picht
author_sort	Francesco Belotti
title	Predicting the Extent of Resection of Motor-Eloquent Gliomas Based on TMS-Guided Fiber Tracking
title_short	Predicting the Extent of Resection of Motor-Eloquent Gliomas Based on TMS-Guided Fiber Tracking
title_full	Predicting the Extent of Resection of Motor-Eloquent Gliomas Based on TMS-Guided Fiber Tracking
title_fullStr	Predicting the Extent of Resection of Motor-Eloquent Gliomas Based on TMS-Guided Fiber Tracking
title_full_unstemmed	Predicting the Extent of Resection of Motor-Eloquent Gliomas Based on TMS-Guided Fiber Tracking
title_sort	predicting the extent of resection of motor-eloquent gliomas based on tms-guided fiber tracking
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/6878826de75d44e1a1928167cc841192
work_keys_str_mv	AT francescobelotti predictingtheextentofresectionofmotoreloquentgliomasbasedontmsguidedfibertracking AT mehmetsalihtuncer predictingtheextentofresectionofmotoreloquentgliomasbasedontmsguidedfibertracking AT tizianrosenstock predictingtheextentofresectionofmotoreloquentgliomasbasedontmsguidedfibertracking AT meltemivren predictingtheextentofresectionofmotoreloquentgliomasbasedontmsguidedfibertracking AT petervajkoczy predictingtheextentofresectionofmotoreloquentgliomasbasedontmsguidedfibertracking AT thomaspicht predictingtheextentofresectionofmotoreloquentgliomasbasedontmsguidedfibertracking
_version_	1718412840991195136

Predicting the Extent of Resection of Motor-Eloquent Gliomas Based on TMS-Guided Fiber Tracking

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