The Impact of Intracranial Tumor Proximity to White Matter Tracts on Morbidity and Mortality: A Retrospective Diffusion Tensor Imaging Study.
Using diffusion tensor imaging (DTI) in neurosurgical planning allows identification of white matter tracts and has been associated with a reduction in postoperative functional deficits.



This study explores the relationship between the lesion-to-tract distance (LTD) and postoperative morbidity and mortality in patients with brain tumors in order to evaluate the role of DTI in predicting postoperative outcomes.



Adult patients with brain tumors (n = 60) underwent preoperative DTI. Three major white matter pathways (superior longitudinal fasciculi [SLF], cingulum, and corticospinal tract) were identified using DTI images, and the shortest LTD was measured for each tract. Postoperative morbidity and mortality information was collected from electronic medical records.



The ipsilesional corticospinal tract LTD and left SLF LTD were significantly associated with the occurrence rate of total postoperative motor (P = .018) and language (P < .001) deficits, respectively. The left SLF LTD was also significantly associated with the occurrence rate of new postoperative language deficits (P = .003), and the LTD threshold that best predicted this occurrence was 1 cm (P < .001). Kaplan–Meier log-rank survival analyses in patients having high-grade tumors demonstrated a significantly higher mortality for patients with a left SLF LTD <1 cm (P = .01).



Measuring tumor proximity to major white matter tracts using DTI can inform clinicians of the likelihood of postoperative functional deficits. A distance of 1 cm or less from eloquent white matter structures most significantly predicts the occurrence of new deficits with current surgical and imaging techniques.
Departments of Radiology, Case Western Reserve Medical School Cleveland, Ohio, USA.|School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Erin J
EJ
Meyer
Departments of Radiology, Case Western Reserve Medical School Cleveland, Ohio, USA.
Wolfgang
W
Gaggl
Departments of Radiology, Case Western Reserve Medical School Cleveland, Ohio, USA.
Benjamin
B
Gilloon
Departments of Radiology, Case Western Reserve Medical School Cleveland, Ohio, USA.
Benjamin
B
Swan
Departments of Radiology, Case Western Reserve Medical School Cleveland, Ohio, USA.
Max
M
Greenstein
Departments of Radiology, Case Western Reserve Medical School Cleveland, Ohio, USA.
Jed
J
Voss
Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
Namath
N
Hussain
Departments of Radiology, Case Western Reserve Medical School Cleveland, Ohio, USA.|University of Wisconsin Madison Hospital and Clinics, Madison, Wisconsin, USA.
Ryan L
RL
Holdsworth
Departments of Radiology, Case Western Reserve Medical School Cleveland, Ohio, USA.
Veena A
VA
Nair
Medical Physics, School of Health,  University of Wisconsin, Madison, USA.|Biomedical Engineering, University of Wisconsin, Madison, USA.
M Elizabeth
ME
Meyerand
Neurological Surgery,  University of Wisconsin Medical School, Madison, Wisconsin, USA.
John S
JS
Kuo
University of Wisconsin Madison Hospital and Clinics, Madison, Wisconsin, USA.|Neurological Surgery,  University of Wisconsin Medical School, Madison, Wisconsin, USA.
Mustafa K
MK
Baskaya
Departments of Radiology, Case Western Reserve Medical School Cleveland, Ohio, USA.|Biomedical Engineering, University of Wisconsin, Madison, USA.
Aaron S
AS
Field
Departments of Radiology, Case Western Reserve Medical School Cleveland, Ohio, USA.|Medical Physics, School of Health,  University of Wisconsin, Madison, USA.
Vivek
V
Prabhakaran
D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D056324:Diffusion Tensor Imaging; D006801:Humans; D009017:Morbidity; D012189:Retrospective Studies; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology
Brain tumor; Diffusion tensor imaging; Morbidity, Mortality; Neurosurgery; White matter