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Elserry
T
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Radiological Low-Grade Glioma; Preoperative DTI and Functional MRI as an Aid in Preoperative Surgical Planning |
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Tarek Elserry MD and Hesham Radwan MD* |
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PNeurosurgery
Department, Faculty of medicine, Ain shams university, Cairo,
Egypt. Accepted September 13, 2018 |
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Abstract |
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Advances in the
understanding of Low-Grade Glioma (LGG) biology have driven new
paradigms in management. However, debate continues pushing the
envelope toward improved quality of life and survival with safe
gross total resection. In this article, we are trying to focus
on the impact of the preoperative radiological data on the plan
of management and intraoperative resection scenario. We applied
a management protocol in our institute, in which we used
functional magnetic resonance image (fMRI) and magnetic
resonance tractography (MRt) data, in a prospective cohort of 56
patients with radiological diagnosis of LGG in the period from
2009 to 2016. Patients were divided depending on the management
strategy into 3 groups: (1) gross total resection (GTR), (2)
biopsy, (3) Don’t touch. Our primary outcome was quality of life
using Karnofsky scale (KPS). Secondary outcomes included: Focal
neurological function and extent of resection. Distribution of
the cases between the groups was 34, 18 and 4 cases in the GTR,
Biopsy and don’t touch groups respectively. We adopted
radiological and clinical follow up every 6 months for a mean
follow up period of 41.5 months. KPS < 70 (dependable) was found
in 17/56 patients at presentation however at 18 months follow up
9/56 cases had KPS < 70 (dependable). Permanent morbidity (more
than 6 months) was reported in 6/56 cases. Functional
radiological preoperative data would be implemented in surgical
decision making for patients with radiological LGG. |
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