2025 Proffered Presentations
S191: CHARACTERIZATION OF WHITE-MATTER CIRCUIT MECHANISMS OF MULTIMODAL SYMPTOMS OF MENINGIOMA FOR SURGICAL GUIDANCE
Min Jae Kim; Sonia Ajmera, MD; Millie Huang; Ritesh Karsalia; Kristen Park; Om Ghandi; Antonio C Tarbay; Sneha S Mannam; Sawaan Sawaan; John Y Lee, MD; Christina Jackson, MD; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, PA, USA
Introduction: Meningiomas are extra-axial tumors that are often symptomatic due to mass effect or associated edema on adjacent cortex. While symptoms due to local mass effect are well-understood, the secondary impact of these tumors on global white matter circuitry has not been extensively explored. Characterizing underlying pre- and post-operative circuitry patterns with clinical outcomes can facilitate surgical planning, clinical guidance, and post-operative management.
Objective: We aimed to develop a pilot model for connectomic analysis in patients with meningiomas to determine the association between white matter circuitry disruption and symptomatology.
Methods: Twenty patients from our institution with convexity meningiomas were reviewed. Pre-operative symptoms were separated into 5 domains: headache, altered mental status, motor deficit, sensory deficit, and gait dysfunction. Tumor volumes were segmented based on preoperative T1 post-contrast images (Figure 1) and seeded into a publicly available normative structural connectome to produce fiber-tracks passing around tumor volumes. Structural connectivity maps were compared between patients with or without symptoms in each domain, and a “T-map” was produced by comparing the number of fiber tracks passing through each voxel via a two-sample t-test.
Results: Within our cohort, 13 patients (65%) presented with motor deficits, 6 (30%) sensory deficits, 6 (30%) gait dysfunction, 10 (50%) headache, and 5 (25%) altered mental status. T-maps identified distinctive cortical and subcortical circuits that are specific to each symptomology (Figure 2-3). ROC analysis revealed that T-map specific for each symptom could reliably reverse-predict either presence or absence of symptoms across the 5 domains (Figure 4). While the circuitry associated with motor and sensory deficits more predictably mapped to their respective white matter tracts, gait disturbance, headache, and altered mental status demonstrated more diffuse connectivity. Strikingly, even a less specific symptom such as headache demonstrated a unique circuit with connectivity to the ventromedial cortex.
Conclusion: Our results identified distinctive sets of white-matter circuits that are associated and predictive of neurological symptomology across 5 domains in meningioma patients. These findings can provide additional guidance in pre-operative surgical decision making. We aim to develop further predictive connectomic models to elucidate the prognostic value of these networks in post-operative outcome that can facilitate surgical planning and post-operative management.
