gms | German Medical Science

Objective: Preoperative tractography enables risk stratification for patients undergoing microsurgical resection of intracerebral tumors. Also, white matter integrity is a prognostic marker for rehabilitation of patients who suffered ischemic stroke. In neurosurgery, damage to the frontal aslant tract (FAT) can cause supplementary motor area (SMA) syndrome, where recovery is hardly predictable.

Methods: We prospectively assessed white matter integrity of the FAT within seven days before and after surgery of intracerebral tumors with magnetic resonance imaging (MRI) by measuring fractional anisotropy (FA) within the tract volume created in diffusion tensor imaging (DTI) tractography. Neurological performance score (NPS), aphasia score, and Janda score were assessed within seven days before and after surgery, as well as at follow-up three months postoperatively. We applied rank order correlation, multivariate regression analysis, and receiver operating characteristic analysis to determine white matter integrity cutoffs for risk stratification.

Results: We included 20 patients with preoperative and postoperative DTI sequence who underwent resection of intracerebral tumors. Perioperative white matter integrity of the left FAT was associated with NPS before surgery (2.38 ± 0.21 versus 1.14 ± 0.14, p = 0.001) and with aphasia score in follow-up three months after surgery (0.0 versus 1.13 ± 0.48, p = 0.008). Perioperative white matter integrity of the right FAT correlated with postoperative NPS (2.08 ± 0.23 versus 1.38 ± 0.26, p = 0.032) and aphasia score (0.71 ± 0.18 versus 0.23 ± 0.17, p = 0.029), as well as with Janda score at follow-up three months after surgery (4.91 ± 0.09 versus 3.67 ± 0.58, p = 0.021).

Conclusion: White matter integrity of the FAT in both hemispheres may predict neurological outcome. This offers new possibilities for patient counseling concerning rehabilitation potential, on which future studies should elaborate.