Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials

Clinical article

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  • 1 Neurochirurgische Klinik und Poliklinik; and
  • 2 Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität, Munich, Germany
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Object

The aim of surgical glioma treatment is the complete resection of tumor tissue while preserving neurological function. Surgery-related neurological deficits arise from direct damage to the cortical or subcortical structures or from ischemia. The authors aimed to assess the incidence of resection-related ischemia of newly diagnosed or recurrent supratentorial gliomas and the sensitivity of intraoperative neuromonitoring (IOM) of motor evoked potentials (MEPs) for detecting such ischemic events and their influence on neurological motor function.

Methods

Between January 2009 and December 2010, 70 patients with tumors in motor-eloquent brain areas underwent intraoperative MEP monitoring during glioma resection and were examined by early postoperative MRI including diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping. Postoperative areas of restricted diffusion were assessed by investigators blinded to the course of intraoperative MEPs and the neurological course.

Results

Among the 70 enrolled patients, a MEP amplitude decline below 50% of the baseline level was observed in 21 patients (30%). Sixteen of these patients (76%) had ischemic lesions identified on postoperative MRI scans. Forty-nine patients (70%) showed no decline in MEP amplitude, and only 16 (33%) of these patients harbored ischemic lesions. Moreover, 9 (69%) of 13 patients with a permanent loss of MEP amplitude showed postoperative ischemic lesions. Factors that promoted the occurrence of postoperative infarction were previous radiotherapy and location of the tumor close to the central arteries.

Conclusions

Alterations in the MEP amplitude during tumor resection and postoperative ischemic lesions are associated with postoperative impairment of motor function. Rather than cortical or subcortical structural damage of eloquent brain tissue alone, peri- or postoperative ischemic lesions play a crucial role in the development of surgery-related motor deficits.

Abbreviations used in this paper:ADC = apparent diffusion coefficient; DW = diffusion-weighted; DWI = DW imaging; IOM = intraoperative neuromonitoring; MEP = motor evoked potential.

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Contributor Notes

Drs. Gempt and Krieg contributed equally to this work.

Address correspondence to: Florian Ringel, M.D., Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675 München, Germany. email: Florian.Ringel@lrz.tum.de.

Please include this information when citing this paper: published online July 5, 2013; DOI: 10.3171/2013.5.JNS121981.

  • 1

    Ammirati M, , Galicich JH, , Arbit E, & Liao Y: Reoperation in the treatment of recurrent intracranial malignant gliomas. Neurosurgery 21:607614, 1987

    • Search Google Scholar
    • Export Citation
  • 2

    Barker FG II, , Chang SM, , Gutin PH, , Malec MK, , McDermott MW, & Prados MD, : Survival and functional status after resection of recurrent glioblastoma multiforme. Neurosurgery 42:709723, 1998

    • Search Google Scholar
    • Export Citation
  • 3

    Bello L, , Gallucci M, , Fava M, , Carrabba G, , Giussani C, & Acerbi F, : Intraoperative subcortical language tract mapping guides surgical removal of gliomas involving speech areas. Neurosurgery 60:6782, 2007

    • Search Google Scholar
    • Export Citation
  • 4

    Chang SM, , Parney IF, , McDermott M, , Barker FG II, , Schmidt MH, & Huang W, : Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg 98:11751181, 2003

    • Search Google Scholar
    • Export Citation
  • 5

    Claus EB, , Horlacher A, , Hsu L, , Schwartz RB, , Dello-Iacono D, & Talos F, : Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer 103:12271233, 2005

    • Search Google Scholar
    • Export Citation
  • 6

    Dützmann S, , Geßler F, , Bink A, , Quick J, , Franz K, & Seifert V, : Risk of ischemia in glioma surgery: comparison of first and repeat procedures. J Neurooncol 107:599607, 2012

    • Search Google Scholar
    • Export Citation
  • 7

    Gempt J, , Förschler A, , Buchmann N, , Pape H, , Ryang YM, & Krieg S, : Postoperative ischemic changes following resection of newly diagnosed and recurrent gliomas and their clinical relevance. Clinical article. J Neurosurg 118:801808, 2013

    • Search Google Scholar
    • Export Citation
  • 8

    Harsh GR IV, , Levin VA, , Gutin PH, , Seager M, , Silver P, & Wilson CB: Reoperation for recurrent glioblastoma and anaplastic astrocytoma. Neurosurgery 21:615621, 1987

    • Search Google Scholar
    • Export Citation
  • 9

    Khan RB, , Gutin PH, , Rai SN, , Zhang L, , Krol G, & DeAngelis LM: Use of diffusion weighted magnetic resonance imaging in predicting early postoperative outcome of new neurological deficits after brain tumor resection. Neurosurgery 59:6066, 2006

    • Search Google Scholar
    • Export Citation
  • 10

    Kombos T, , Picht T, , Derdilopoulos A, & Suess O: Impact of intraoperative neurophysiological monitoring on surgery of high-grade gliomas. J Clin Neurophysiol 26:422425, 2009

    • Search Google Scholar
    • Export Citation
  • 11

    Krieg SM, , Buchmann NH, , Gempt J, , Shiban E, , Meyer B, & Ringel F: Diffusion tensor imaging fiber tracking using navigated brain stimulation—a feasibility study. Acta Neurochir (Wien) 154:555563, 2012

    • Search Google Scholar
    • Export Citation
  • 12

    Krieg SM, , Shiban E, , Buchmann N, , Gempt J, , Foerschler A, & Meyer B, : Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. Clinical article. J Neurosurg 116:9941001, 2012

    • Search Google Scholar
    • Export Citation
  • 13

    Krieg SM, , Shiban E, , Droese D, , Gempt J, , Buchmann N, & Pape H, : Predictive value and safety of intraoperative neurophysiological monitoring using motor evoked potentials in glioma surgery. Neurosurgery 70:10601071, 2012

    • Search Google Scholar
    • Export Citation
  • 14

    Kumabe T, , Higano S, , Takahashi S, & Tominaga T: Ischemic complications associated with resection of opercular glioma. J Neurosurg 106:263269, 2007

    • Search Google Scholar
    • Export Citation
  • 15

    Nabavi A, , Thurm H, , Zountsas B, , Pietsch T, , Lanfermann H, & Pichlmeier U, : Five-aminolevulinic acid for fluorescence-guided resection of recurrent malignant gliomas: a phase ii study. Neurosurgery 65:10701077, 2009

    • Search Google Scholar
    • Export Citation
  • 16

    Neuloh G, , Pechstein U, , Cedzich C, & Schramm J: Motor evoked potential monitoring with supratentorial surgery. Neurosurgery 61:1 Suppl 337348, 2007

    • Search Google Scholar
    • Export Citation
  • 17

    Neuloh G, , Pechstein U, & Schramm J: Motor tract monitoring during insular glioma surgery. J Neurosurg 106:582592, 2007

  • 18

    Neuloh G, & Schramm J: Are there false-negative results of motor evoked potential monitoring in brain surgery?. Cent Eur Neurosurg 70:171175, 2009

    • Search Google Scholar
    • Export Citation
  • 19

    Park JK, , Hodges T, , Arko L, , Shen M, , Dello Iacono D, & McNabb A, : Scale to predict survival after surgery for recurrent glioblastoma multiforme. J Clin Oncol 28:38383843, 2010

    • Search Google Scholar
    • Export Citation
  • 20

    Polin RS, , Marko NF, , Ammerman MD, , Shaffrey ME, , Huang W, & Anderson FA Jr, : Functional outcomes and survival in patients with high-grade gliomas in dominant and nondominant hemispheres. J Neurosurg 102:276283, 2005

    • Search Google Scholar
    • Export Citation
  • 21

    Smith JS, , Cha S, , Mayo MC, , McDermott MW, , Parsa AT, & Chang SM, : Serial diffusion-weighted magnetic resonance imaging in cases of glioma: distinguishing tumor recurrence from postresection injury. J Neurosurg 103:428438, 2005

    • Search Google Scholar
    • Export Citation
  • 22

    Smith JS, , Chang EF, , Lamborn KR, , Chang SM, , Prados MD, & Cha S, : Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:13381345, 2008

    • Search Google Scholar
    • Export Citation
  • 23

    Smith JS, , Lin H, , Mayo MC, , Bannerjee A, , Gupta N, & Perry V, : Diffusion-weighted MR imaging abnormalities in pediatric patients with surgically-treated intracranial mass lesions. J Neurooncol 79:203209, 2006

    • Search Google Scholar
    • Export Citation
  • 24

    Stummer W, , Pichlmeier U, , Meinel T, , Wiestler OD, , Zanella F, & Reulen HJ: Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:392401, 2006

    • Search Google Scholar
    • Export Citation
  • 25

    Suess O, , Kombos T, , Ciklatekerlio O, , Stendel R, , Suess S, & Brock M: Impact of brain shift on intraoperative neurophysiological monitoring with cortical strip electrodes. Acta Neurochir (Wien) 144:12791289, 2002

    • Search Google Scholar
    • Export Citation
  • 26

    Taylor MD, & Bernstein M: Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg 90:3541, 1999

    • Search Google Scholar
    • Export Citation
  • 27

    Ulmer S, , Braga TA, , Barker FG II, , Lev MH, , Gonzalez RG, & Henson JW: Clinical and radiographic features of peritumoral infarction following resection of glioblastoma. Neurology 67:16681670, 2006

    • Search Google Scholar
    • Export Citation
  • 28

    Vick NA, , Ciric IS, , Eller TW, , Cozzens JW, & Walsh A: Reoperation for malignant astrocytoma. Neurology 39:430432, 1989

  • 29

    Young B, , Oldfield EH, , Markesbery WR, , Haack D, , Tibbs PA, & McCombs P, : Reoperation for glioblastoma. J Neurosurg 55:917921, 1981

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