The Role of DTI in Surgical Management of Brainstem Cavernous Malformations: A Meta-analysis of 4,159 Cases

Objective: This article aims to compare outcomes of diffusion tensor imaging (DTI) versus conventional magnetic resonance imaging (MRI) or computed tomography (CT) in the surgical management of brainstem cavernous malformations (BSCM).

Methods: A systematic review and meta-analysis of 106 studies, including 4,159 patients with BSCM, was conducted. Patients were stratified into two cohorts: those who received DTI/DTT (n = 382) and those who received only MRI/CT (n = 3,777). Primary outcomes included gross total resection rates, clinical improvement, and worsening.

Results: The DTI/DTT cohort demonstrated a significantly higher gross total resection rate compared to the MRI/CT cohort (94.9 vs. 87.0%, p = 0.025). Clinical improvement was observed in 71.5% of the DTI/DTT group versus 65.6% in the MRI/CT group (p = 0.343). The DTI/DTT group showed a significantly lower rate of clinical worsening (5.1 vs. 11.4%, p = 0.038). No significant differences were found in complication rates between the two groups (45.0 vs. 36.1%, p = 0.394). Multivariate regression analysis revealed that medullary location negatively impacted gross total resection rates in the DTI/DTT cohort (p = 0.0293).

Conclusion: The use of DTI/DTT in the surgical management of BSCM is associated with higher gross total resection rates and lower rates of clinical worsening compared to conventional MRI/CT alone.

Demographics, clinical presentation, and location of BSCM in DTI/DTT and MRI/CT cohorts
Variable	DTI/DTT	MRI/CT	p-Value
Age (years)	37.83 ± 10.26	37.87 ± 12.02	0.988
Male:Female ratio	0.877 ± 0.66	0.875 ± 075	0.989
mRS score	1.87 ± 0.51	2.55 ± 0.91	0.015
Motor deficits (%)	55.8	49.2	0.559
CN deficits (%)	87.0	62.9	0.263
Midbrain (%)	22.5	25.3	0.643
Pons (%)	61.6	58.02	0.659
Medulla (%)	14.0	19.4	0.387
Size of major diameter (mm)	15.96 ± 4.45	18.4 ± 4.93	0.172

Postoperative outcomes in BSCM in DTI/DTT and MRI/CT cohorts
Variable	DTI/DTT	MRI/CT	p-Value
Follow-up (mo)	92.02 ± 107.8	133.9 ± 114.2	0.184
GTR (%)	94.9 ± 5.09	87.0 ± 25.1	0.025
Improved (%)	71.5 ± 22.4	65.6 ± 25.5	0.343
Worse (%)	5.1 ± 9.7	11.4 ± 15.6	0.038
Complications (%)	45.0	36.1	0.394

Multivariate regression of percent gross total resection in the DTI/DTT cohort against demographic, clinical presentation, and location
Predictor	Estimate	SE	p-Value
Age	−0.1238	0.1152	0.3430
Male:Female ratio	−0.2487	1.6799	0.8895
Motor deficits	−0.1669	0.2716	0.5722
CN neuropathy	0.6930	0.2554	0.0534
Midbrain	−1.2540	0.5673	0.0916
Pons	0.1803	0.2430	0.4994
Medulla	−1.3769	0.4141	0.0293

Publikationsverlauf

Artikel online veröffentlicht:
07. Februar 2025