Long-term clinical prognosis of patients with gliomas infiltrating corticospinal tract on DTI tractography

TL;DR

This study examines the long-term outcomes of glioma patients with corticospinal tract infiltration and suggests careful surgical strategies to preserve motor function.

Contribution

The study identifies risk factors for postoperative paralysis and provides insights into surgical and oncological outcomes for glioma patients with CST infiltration.

Findings

Patients with high-grade gliomas and pre-operative motor deficits had a higher risk of permanent paralysis.

Low tumor grade and IDH1 mutation were independent factors for longer progression-free survival.

Preoperative DTI tractography helps determine CST involvement and guide surgical decisions.

Abstract

The infiltration of the corticospinal tract (CST) in patients with gliomas may lead to more postoperative paralysis and worse survival than others. The aim of this study is to investigate the clinical outcomes and propose the surgical strategy for these patients.

We retrospectively identified 101 patients with CST infiltrated by cerebral gliomas on preoperative DTI tractography. Surgical, neurologic, and oncological outcomes were assessed on long-term follow-up.

Forty-eight (47.5%) patients harbored grade II gliomas, 26 (25.7%) had grade III gliomas, and 27 (26.7%) had grade IV gliomas. Gross-total resection (GTR) or subtotal resection (STR) was achieved in 67.3% of patients, and partial resection (PR) was achieved in 32.7% of patients. Large tumors (≥ 24.5 ml) and low-grade gliomas (LGGs) were independent prognostic factors for partial resection. Patients with high-grade gliomas (HGGs) and pre-operative motor deficit had a higher risk for permanent paralysis. Thirty-three of 101 patients (32.7%) had long-term paralysis, and 7 patients (6.9%) suffered from severe paralysis. The median PFS and OS were 12 months and 24 months in grade IV gliomas. In multivariate analysis using the Cox model, low tumor grade and IDH1 mutation were independent factors for longer PFS, and low tumor grade was an independent factor for longer OS.

Preoperative DTI tractography is a valuable tool for determining the extent of CST involvement in patients with gliomas. The risk of postoperative paralysis is extremely high; therefore, careful and conservative resection should be performed to preserve motor function. Despite this challenge, patients can still achieve positive oncological outcomes with standard adjuvant therapy after surgery.

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