The role of blood oxygenation level-dependent functional magnetic resonance imaging(BOLD-fMRI) combined with diffusion tensor imaging(DTI) in surgery for tumors involving motor pathways

Objective:Blood oxygenation level-dependent functional magnetic resonance imaging(BOLD-fMRI)in combination with diffusion tensor imaging(DTI)can clearly show the specific relationship between brain tumors and motor pathways.The purpose of this study was to investigate the role of this combination in surgery for brain tumors involving motor pathways.Methods:From September 2018 to March 2019,preoperative BOLD-fM RI and DTI examinations were performed in patients with brain tumors involving motor pathways who were being treated in a neurosurgery department.The patients were divided into two groups according to the combined examination results.In one group,the motor pathways were intact;in the other,motor pathways were infiltrated by tumors.The surgical plan was total resection of the tumor as far as possible and with no damage to the motor pathway.The preoperative and postoperative motor dysfunction and the rate of total resection in the two groups were compared.Results:Of the 20 patients with intact motor pathways,15 had normal preoperative motor function,and 5 had preoperative motor dysfunction;of those 5 patients,3 exhibited postoperative aggravation of motor dysfunction.Total excision was performed in 16 patients with intact motor pathways and incomplete excision in 4.Of the 22 patients with motor pathway infiltration,8 had normal preoperative motor function and 14 had preoperative motor dysfunction;of those14,10 exhibited a postoperative increase in motor dysfunction.Total excision was performed in 8 patients with infiltrated motor pathways and incomplete excision in 14.Statistical analysis showed that there were significant differences between the two groups in preoperative motor function,postoperative changes in motor function,and total surgical resection rate(all p<0.05).Conclusions:First,whether tumors invade the motor pathway is an important factor affecting the degree of preoperative motor dysfunction.Second,the risk for postoperative motor dysfunction was lower in patients with intact motor pathways than in patients with infiltrated motor pathways.Third,the rate of total tumor resection was higher in patients with intact motor pathways than in patients with infiltrated motor pathways.Last,the combination of BOLD-fM RI and DTI aided in the decision to perform total resection.

Effect of hemorrhagic cerebrospinal fluid drainage on cognitive function after intracranial aneurysm clipping

Objective:The effects of repeated lumbar puncture and continuous lumbar cistern drainage on the cognitive function of patients with aneurysmal subarachnoid hemorrhage were compared and analyzed.Methods:Retrospective analysis was performed on 59 patients with aneurysmal subarachnoid hemorrhage treated at our Neurosurgery Department between October 2017 and October 2018.According to the hemorrhagic cerebrospinal fluid drainage mode after aneurysm clipping,the patients were divided into the following two groups:the repeated lumbar puncture drainage(Group A,n=28)and continuous lumbar cistern drainage(Group B,n=31).Before and 1 month after surgery,the cognitive function of the patients was scored using the Montreal Cognitive Assessment Scale.Scores of 27~30 were defined as normal,and scores of<27 as cognitive impairment.Results:The incidences of cognitive impairment were 46%(13/28)and 32%(10/31)for Groups A and B,respectively,before surgery,but the difference was not significant(P>0.05).The incidences of cognitive impairment were 35%(10/28)and 12%(4/31)for Groups A and B,respectively,at 1 month after surgery,with significant difference(P<0.05).Conclusion:Compared with repeated lumbar puncture,continuous lumbar cistern drainage for aneurysmal subarachnoid hemorrhage significantly reduced the incidence of cognitive impairment after aneurysm clipping.