Preserved White Matter Integrity and Recovery After Brain Tumor Surgery: A Prospective Pilot Study on the Frontal Aslant Tract

Abstract

Introduction:

Damage to white matter tracts can cause severe neurological deficits, which are often hardly predictable before brain tumor surgery. To explore the possibility of assessing white matter integrity and its preservation, we chose the frontal aslant tract (FAT) due to its involvement in multiple neurological functions such as speech and movement initiation.

Methods:

Right-handed patients with left hemispheric intracerebral tumors underwent FAT tractography within 7 days before and 3 days after surgery. Neurological performance score and aphasia score were assessed within 7 days before and after surgery, as well as at follow-up 3 months postoperatively.

Results:

Fifteen patients were prospectively analyzed. After multivariate analysis and receiver operating characteristic analysis, we found that preoperative fractional anisotropy (FA) of the left FAT indicated the preoperative aphasia score (cutoff 0.40, p = 0.015). Aphasia scores 3 months postoperatively were predicted by both postoperative FA of the left FAT (cutoff 0.35, p = 0.005) and postoperatively preserved FA of the left FAT (cutoff 95.8%, p = 0.017). Postoperatively preserved right FAT FA inversely predicted postoperative aphasia score (cutoff 95.1%, p = 0.016).

Discussion:

Assessment of white matter integrity preservation is possible and correlates with outcome after brain tumor surgery. It may be useful for patient counseling and assessment of rehabilitation potential, as well as to investigate relevant brain networks in the future.

Clinical Trial Registration:

The trial was prospectively registered at ClinicalTrials.gov (NCT04302857).

Impact statement

Tractography is a valuable tool for planning neurosurgical procedures. It informs the clinician of individual anatomy to tailor the surgical strategy, and it also holds great value for risk assessment before brain tumor resection. Another important question for surgeons and patients is the estimation of rehabilitation potential after surgery when neurological deterioration of some degree may have occurred. We, therefore, repeated tractography in the postoperative phase to assess postoperative damage. The results of this pilot study show that this approach is feasible and may aid in postoperative patient counseling, decision-making, and further brain network investigations.