title: Postoperative ischemic changes after glioma resection identified by diffusion-weighted magnetic resonance imaging and their association with intraoperative motor evoked potentials.
abstract: OBJECTIVE
  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.
authors.affiliation: Neurochirurgische Klinik und Poliklinik; and.
authors.forename: Jens
authors.initials: J
authors.lastname: Gempt
authors.forename: Sandro M
authors.initials: SM
authors.lastname: Krieg
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hüttinger
authors.forename: Niels
authors.initials: N
authors.lastname: Buchmann
authors.forename: Yu-Mi
authors.initials: YM
authors.lastname: Ryang
authors.forename: Ehab
authors.initials: E
authors.lastname: Shiban
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meyer
authors.forename: Claus
authors.initials: C
authors.lastname: Zimmer
authors.forename: Annette
authors.initials: A
authors.lastname: Förschler
authors.forename: Florian
authors.initials: F
authors.lastname: Ringel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000503:physiopathology*; D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology*; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000503:physiopathology / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D005910:Glioma / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011184:Postoperative Period; D016896:Treatment Outcome