Functional Monitoring for Motor Pathway in Brain Tumor Surgery Within Eloquent Area

• ClinicalTrials.gov Identifier: NCT01351337
• Recruitment Status: Completed
• First Posted: May 10, 2011
• Results First Posted: April 20, 2015
• Last Update Posted: April 20, 2015
• Sponsor: Huashan Hospital
• Collaborator: Shanghai Municipal Science and Technology Commission
• Information provided by (Responsible Party): Jinsong Wu, Huashan Hospital

Study Description

Brief Summary:

Resection of brain tumors in eloquent areas involves the risk of postoperative motor deficits. For brain tumors within or adjacent to the eloquent area, maximizing tumor resection while preserving motor function is crucially important.we used DTI-based tractography to visualize the spatial relationship between brain lesions and the nearby pyramidal tract(PT) in patients with malignant brain tumors and confirmed functional connections of the illustrated PT by direct electrical stimulation. We evaluated the reliability of DTI-based tractography for PT mapping using intraoperative subcortical stimulation ) and the usefulness of the combination of two techniques.

Condition or disease	Intervention/treatment	Phase
Glioma, Motor Pathway	Procedure: diffusion tensor tractography neuronavigation and intraoperative subcortical stimulation	Not Applicable

Detailed Description:

Adverse effects caused by electrical stimulation during the operation were recorded. All subjects adopted early postoperative MRI examinations (within 3 days) to evaluate both the extent of tumor resection and the integrity of the PTs. Muscle strength was assessed preoperatively and postoperatively.The Karnofsky Performance Scale (KPS) was adopted for grading functional status at the 6-month evaluation. Further tumor progression interval and survival analysis was conducted for each subject with high-grade glioma (HGG)

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 58 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: Single (Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Clinical Efficiency of Motor Pathway Mapping Using Diffusion Tensor Imaging Tractography and Intraoperative Subcortical Stimulation in Cerebral Glioma Surgery
• Study Start Date: October 2008
• Actual Primary Completion Date: June 2009
• Actual Study Completion Date: February 2013

Arms and Interventions

Arm	Intervention/treatment
intraoperative functional monitoring; intraoperative functional monitoring	Procedure: diffusion tensor tractography neuronavigation and intraoperative subcortical stimulation; All of the patients underwent tumor resection assisted with combined use of Diffusion tensor tractography-integrated functional neuronavigation and intraoperative subcortical stimulation

Outcome Measures

Primary Outcome Measures :

1. Extent of Tumor Resection [ Time Frame: within 3 days ]
   Volumetric analysis was performed both before and after surgery by calculating the tumor volume on the images of enhanced 3-D MP-RAGE sequence for high-grade gliomas and FLAIR sequence for low-grade gliomas. The extent of tumor resection was the ratio of pre-op tumor volume over post-op tumor volume. Gross total resection refers to a 100% resection of the tumor volume; near-total resection refers to 95% to 100% resection; subtotal resection refers to 90% to 95% resection; partial resection refers to 75% to 90% resection; and biopsy refers to ,75% resection of the tumor volume for histological diagnosis.

Secondary Outcome Measures :

1. Postoperative Motor Function and Long-time Functional Status [ Time Frame: 3 days to 6 months after surgery ]
   Motor function was assessed early postoperatively (within 72 hours after the operation), and 1 month after discharge. The muscle strength of each subject was graded for both the upper and lower extremities with the Medical Research Council Scale. Grade 5: Muscle contracts against full resistance; Grade 4: Strength reduced, but contraction can still move joint against resistance; Grade 3: Strength further reduced such that joint can be moved only against gravity with examiner's resistance completely removed. Grade 2: Muscle can onlly move if resistance of gravity is removed. Grade 1: Only a trace or flicker of movement is seen or felt, or fasciculations are observed; Grade 0:No movement.

Other Outcome Measures:

1. The Specificity, Sentitivity of DTI Tractography and Accordance Rate of DTI With DsCS Results [ Time Frame: During the operation ]
   The sensitivity of DTI tractography for PT mapping was calculated as the ratio between the number of subjects with positive DsCS results in the positive DTI zone (true positive) and the total number of subjects with positive DsCS results (true positive plus false negative). The specificity was measured as the ratio between the number of subjects with negative DsCS results in the negative DTI zone (true negative) and the total number of subjects with negative DsCS results (true negative plus false positive). The accordance rate of DsCS and DTI was measured as the ratio between the number of subjects with either a true-positive or true-negative DsCS result and the total number of subjects.

Eligibility Criteria

• Ages Eligible for Study: 6 Years to 75 Years (Child, Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• patients with an initial imaging diagnosis of single, unilateral, supratentorial primary glioma (or intrinsic neoplasm).
• The lesions were involved in PTs, comprising cortical regions in the motor or somatosensory areas, cortical regions adjacent to the central gyrus, subcortical regions with an infiltrative progression along the PTs, and temporal or insular regions in relation to the internal capsule.
• MRI enabled preoperative identification of patients in whom maximal tumor resection was likely to be achieved, and close PT approach within resection cavity at the time of surgery was possible.

Exclusion Criteria:

• patients with secondary or recurrent gliomas (or intrinsic neoplasm), patients with contraindications for MRI or direct electrical stimulation, and patients in whom initial muscle strength grades of the affected extremities was 2/5 or lower.

Contacts and Locations

Locations

China, Shanghai

Hushan Hospital, Fudan University

Shanghai, Shanghai, China, 200000

Sponsors and Collaborators

Huashan Hospital

Shanghai Municipal Science and Technology Commission

Investigators

• Study Chair: Liangfu Zhou, Doctorate; Huashan Hospital

More Information

Publications of Results:

Zhu FP, Wu JS, Song YY, Yao CJ, Zhuang DX, Xu G, Tang WJ, Qin ZY, Mao Y, Zhou LF. Clinical application of motor pathway mapping using diffusion tensor imaging tractography and intraoperative direct subcortical stimulation in cerebral glioma surgery: a prospective cohort study. Neurosurgery. 2012 Dec;71(6):1170-83; discussion 1183-4. doi: 10.1227/NEU.0b013e318271bc61.

• Responsible Party: Jinsong Wu, professor, Huashan Hospital
• ClinicalTrials.gov Identifier: NCT01351337
• Other Study ID Numbers: 07QA14008; 07QA14008 ( Other Grant/Funding Number: The govermment of Shanghai, China )
• First Posted: May 10, 2011
• Results First Posted: April 20, 2015
• Last Update Posted: April 20, 2015
• Last Verified: April 2015

Keywords provided by Jinsong Wu, Huashan Hospital:

Diffusion tensor imaging, Glioma, Intraoperative monitoring, Pyramidal tract, Subcortical; stimulation, Tractography

Additional relevant MeSH terms:

Glioma; Neoplasms, Neuroepithelial; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms by Histologic Type; Neoplasms; Neoplasms, Glandular and Epithelial; Neoplasms, Nerve Tissue