Brain infarctions after glioma surgery: prevalence, radiological characteristics and risk factors

Abstract

Background Prevalence, radiological characteristics, and risk factors for peritumoral infarctions after glioma surgery are not much studied. In this study, we assessed shape, volume, and prevalence of peritumoral infarctions and investigated possible associated factors. Methods In a prospective single-center cohort study, we included all adult patients operated for diffuse gliomas from January 2007 to December 2018. Postoperative infarctions were segmented using early postoperative MRI images, and volume, shape, and location of postoperative infarctions were assessed. Heatmaps of the distribution of tumors and infarctions were created. Results MRIs from 238 (44%) of 539 operations showed restricted diffusion in relation to the operation cavity, interpreted as postoperative infarctions. Of these, 86 (36%) were rim-shaped, 103 (43%) were sector-shaped, 40 (17%) were a combination of rim- and sector-shaped, and six (3%) were remote infarctions. Median infarction volume was 1.7 cm3 (IQR 0.7–4.3, range 0.1–67.1). Infarctions were more common if the tumor was in the temporal lobe, and the map shows more infarctions in the periventricular watershed areas. Sector-shaped infarctions were more often seen in patients with known cerebrovascular disease (47.6% vs. 25.5%, p = 0.024). There was a positive correlation between infarction volume and tumor volume (r = 0.267, p < 0.001) and infarction volume and perioperative bleeding (r = 0.176, p = 0.014). Moreover, there was a significant positive association between age and larger infarction volumes (r = 0.193, p = 0.003). Infarction rates and infarction volumes varied across individual surgeons, p = 0.037 (range 32–72%) and p = 0.026. Conclusions In the present study, peritumoral infarctions occurred in 44% after diffuse glioma operations. Infarctions were more common in patients operated for tumors in the temporal lobe but were not more common following recurrent surgeries. Sector-shaped infarctions were more common in patients with known cerebrovascular disease. Increasing age, larger tumors, and more perioperative bleeding were factors associated with infarction volumes. The risk of infarctions and infarction volumes may also be surgeon-dependent.

Brain infarction following meningioma surgery—incidence, risk factors, and impact on function, seizure risk, and patient-reported quality of life

“…Our postoperative MRI protocols and routines for segmentation of infarctions and tumors have been described in detail earlier [ 26 ]. Briefly, infarctions were detected using postoperative B100 sequences on diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) maps.…”

“…Although there is an increased awareness of the importance of peritumoral infarctions related to glioma surgery [ 1 , 4 , 8 , 12 , 23 , 26 , 28 ], peritumoral infarctions after meningioma resection are less studied and the main focus has been on venous infarctions [ 27 ]. However, a recent publication with 122 patients found that an area with MR restricted diffusion over 1 cm was seen after 22% of meningioma operations and was associated with postoperative deficits [ 16 ].…”

Clinical and prognostic implications of rim restriction following glioma surgery

“…The incidence rates of postoperative rim restriction reportedly ranged from 16 to 39%, yet previous studies encompassed various types of tumors and also included patients that sustained intra-operative ischemic strokes, which as well present with restrictive changes on post-operative DWI. 12 , 13 , 23…”

“…Post-operative diffusion restriction is thought to result from cellular injury and swelling which decreases the movement of protons 7 , 8 . As opposed to intra-operative strokes which are occasionally demonstrated by post-operative DWI and have been discussed in depth in the past, the etiology and clinical impact of peri-resection rim restriction remain unclear 9 – 12 . Cases with this imaging finding have been either excluded from studies dealing with perioperative ischemic complications or incorporated into groups of combined ischemic lesions.…”

“…Cases with this imaging finding have been either excluded from studies dealing with perioperative ischemic complications or incorporated into groups of combined ischemic lesions. Furthermore, these studies have often been composed of a variety of types of tumors 10 , 12 – 15 .…”