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Intraoperative use and benefits of tractography in awake surgery patients
EANS Academy. de Quintana-Schmidt C. 09/26/19; 276006; EP03096
Cristian de Quintana-Schmidt
Cristian de Quintana-Schmidt

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Abstract
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Background: Intraoperative tractography is widely used although comparative studies reporting the benefits of this technology are scarce in the literature.
Methods: We present a prospective cohort study with two groups of patients undergoing awake surgery for brain tumor resection. The case group had intraoperative tractography available (Group A) and the control group did not (Group B); different intra-operative and post-operative variables were registered and compared. Secondarily, the power of pre-operative DTI to predict complete tumor resection was analyzed.
Results: N= 37 (Group A = 19 vs Group B = 18). Mean Age: Group A= 53 vs Group B = 51 (p=0.750). Histology Group A: 10 high grade gliomas, 6 low grade gliomas and 3 metastases vs Histology Group B: 8 high grade gliomas, 6 low grade gliomas and 4 metastases (p=0.763). Mean Tumor size (cm3): Group A=25.6 vs Group B=36 (p=0.383).
The awake time of the surgery in Group A was 93.6 (SD 12.2) minutes and in Group B was 119.8 (SD 31.1). Tractography shortened the average time by 26.2 minutes [CI95% 10.5-42 minutes] (p=0.007).
Sensitivity and Specificity rates for predicting complete tumor resection were calculated for both groups: sensitivity and specificity were 100% and 80% respectively for Group A, compared with 88% and 62,5% for Group B. The ROC area was 0.966 in Group A vs 0.720 in Group B (p=0.04).
Conclusions: Intraoperative tractography helps shorten the time of awake neuro-oncological surgery. Moreover, our results showed tractography used in preoperative planning to be a useful tool for predicting a complete tumor resection
Background: Intraoperative tractography is widely used although comparative studies reporting the benefits of this technology are scarce in the literature.
Methods: We present a prospective cohort study with two groups of patients undergoing awake surgery for brain tumor resection. The case group had intraoperative tractography available (Group A) and the control group did not (Group B); different intra-operative and post-operative variables were registered and compared. Secondarily, the power of pre-operative DTI to predict complete tumor resection was analyzed.
Results: N= 37 (Group A = 19 vs Group B = 18). Mean Age: Group A= 53 vs Group B = 51 (p=0.750). Histology Group A: 10 high grade gliomas, 6 low grade gliomas and 3 metastases vs Histology Group B: 8 high grade gliomas, 6 low grade gliomas and 4 metastases (p=0.763). Mean Tumor size (cm3): Group A=25.6 vs Group B=36 (p=0.383).
The awake time of the surgery in Group A was 93.6 (SD 12.2) minutes and in Group B was 119.8 (SD 31.1). Tractography shortened the average time by 26.2 minutes [CI95% 10.5-42 minutes] (p=0.007).
Sensitivity and Specificity rates for predicting complete tumor resection were calculated for both groups: sensitivity and specificity were 100% and 80% respectively for Group A, compared with 88% and 62,5% for Group B. The ROC area was 0.966 in Group A vs 0.720 in Group B (p=0.04).
Conclusions: Intraoperative tractography helps shorten the time of awake neuro-oncological surgery. Moreover, our results showed tractography used in preoperative planning to be a useful tool for predicting a complete tumor resection
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