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Hotspots of small strokes in glioma surgery: an overlooked risk?

  • Marie-Pierre Loit
  • François Rheault
  • Etienne Gayat
  • Isabelle Poisson
  • Sébastien Froelich
  • Nanxi Zhi
  • Stéphane Velut
  • Emmanuel Mandonnet
Original Article - Tumor - Glioma
Part of the following topical collections:
  1. Tumor – Glioma

Abstract

Background

Small deep infarcts constitute a well-known risk of motor and speech deficit in insulo-opercular glioma surgery. However, the risk of cognitive deterioration in relation to stroke occurrence in so-called silent areas is poorly known. In this paper, we propose to build a distribution map of small deep infarcts in glioma surgery, and to analyze patients’ cognitive outcome in relation to stroke occurrence.

Methods

We retrospectively studied a consecutive series of patients operated on for a diffuse glioma between June 2011and June 2017. Patients with lower-grade glioma were cognitively assessed, both before and 4 months after surgery. Areas of decreased apparent diffusion coefficient (ADC) on the immediate postoperative MRI were segmented. All images were registered in the MNI reference by ANTS algorithm, allowing to build a distribution map of the strokes. Stroke occurrence was correlated with the postoperative changes in semantic fluency score in the lower-grade glioma cohort.

Results

One hundred fifteen patients were included. Areas of reduced ADC were observed in 27 out of 54 (50%) patients with a lower-grade glioma, and 25 out of 61 (41%) patients with a glioblastoma. Median volume was 1.6 cc. The distribution map revealed five clusters of deep strokes, corresponding respectively to callosal, prefrontal, insulo-opercular, parietal, and temporal tumor locations. No motor nor speech long-term deficits were caused by these strokes. Cognitive evaluations at 4 months showed that the presence of small infarcts correlated with a slight decrease of semantic fluency scores.

Conclusion

Deep small infarcts are commonly found after glioma surgery, but their actual impact in terms of patients’ quality of life remains to be demonstrated. Further studies are needed to better evaluate the cognitive consequences—if any—for each of the described hotspots and to identify risk factors other than the surgery-induced damage of microvessels.

Keywords

Strokes Glioma Surgery Cognitive outcome 

Notes

Acknowledgements

EM thanks Pr Duffau for fruitful discussions about this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

All patients signed a written informed consent for retrospective analysis of their clinical and radiological data, although due to the retrospective nature of the study, formal consent is not required.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Université Paris 7 DiderotParisFrance
  2. 2.Department of NeurosurgeryLariboisière HospitalParisFrance
  3. 3.Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science DepartmentUniversité de SherbrookeSherbrookeCanada
  4. 4.Department of AnesthesiologyLariboisière HospitalParisFrance
  5. 5.Université François-Rabelais de ToursInserm, Imagerie et cerveau UMR U930ToursFrance
  6. 6.Department of NeurosurgeryCHRU de ToursToursFrance
  7. 7.Frontlab, INSERMInstitut du Cerveau et de la Moelle (ICM)ParisFrance

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