Clinical and prognostic implications of rim restriction following glioma surgery.

in Scientific reports by Assaf Berger, Garry Gali Tzarfati, Marga Serafimova, Pablo Valdes, Aaron Meller, Akiva Korn, Naomi Kahana Levy, Daniel Aviram, Zvi Ram, Rachel Grossman

TLDR

  • Rim restriction on post-operative imaging is associated with longer surgery duration and potentially linked to brain retraction, and may be linked to higher rates of speech deficits in LGG dominant-side surgeries.

Abstract

Rim restriction surrounding the resection cavity of glioma is often seen on immediate post-op diffusion-weighted imaging (DWI). The etiology and clinical impact of rim restriction are unknown. We evaluated the incidence, risk factors and clinical consequences of this finding. We evaluated patients that underwent surgery for low-grade glioma (LGG) and glioblastoma (GBM) without stroke on post-operative imaging. Analyses encompassed pre- and postoperative clinical, radiological, intraoperative monitoring, survival, functional and neurocognitive outcomes. Between 2013 and 2017, 63 LGG and 209 GBM patients (272 in total) underwent surgical resection and were included in our cohort. Post-op rim restriction was demonstrated in 68 patients, 32% (n = 20) of LGG and 23% (n = 48) of GBM patients. Risk factors for restriction included temporal tumors in GBM (p = 0.025) and insular tumors in LGG (p = 0.09), including longer surgery duration in LGG (p = 0.008). After a 1-year follow-up, LGG patients operated on their dominant with post-op restriction had a higher rate of speech deficits (46 vs 9%, p = 0.004). Rim restriction on postoperative imaging is associated with longer duration of glioma surgery and potentially linked to brain retraction. It apparently has no direct clinical consequences, but is linked to higher rates of speech deficits in LGG dominant-side surgeries.

Overview

  • The study aimed to evaluate the incidence, risk factors, and clinical consequences of rim restriction surrounding the resection cavity of glioma on immediate post-op diffusion-weighted imaging (DWI).
  • The study included 272 patients with low-grade glioma (LGG) and glioblastoma (GBM) who underwent surgical resection and post-operative imaging.
  • The primary objective was to investigate the association between rim restriction and clinical outcomes, including survival, functional, and neurocognitive outcomes.

Comparative Analysis & Findings

  • Post-op rim restriction was demonstrated in 68 patients, with a higher incidence in GBM patients (23%) compared to LGG patients (32%).
  • Risk factors for restriction included temporal tumors in GBM and insular tumors in LGG, as well as longer surgery duration in LGG.
  • After 1-year follow-up, LGG patients operated on the dominant side with post-op restriction had a higher rate of speech deficits (46% vs 9%, p = 0.004).

Implications and Future Directions

  • Rim restriction may be associated with longer duration of glioma surgery and potentially linked to brain retraction, but more studies are needed to confirm this finding.
  • Further research is required to elucidate the underlying mechanisms of rim restriction and its potential impact on clinical outcomes in patients with LGG and GBM.
  • The study highlights the importance of careful pre-operative planning and intraoperative navigation to minimize the risk of rim restriction and its potential consequences.
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