2025 Proffered Presentations

 

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S204: THE ROLE OF DTI IN SURGICAL MANAGEMENT OF BRAINSTEM CAVERNOUS MALFORMATIONS: A META-ANALYSIS OF 4,159 CASES
Brandon M Edelbach, BS¹; Ahmad K AlMekkawi, MD²; Ananya Sharma, BS³; Nikitha Sheth, BS³; Paras Shah, BS³; Eshanika Manchanda, BS³; Carlos A Bagley, MD, MBA²; Jonathan D Breshears, MD²; Yifei Duan, MD²; ¹Loma Linda Univeristy School of Medicine; ²Saint Luke's Marion Bloch Neuroscience Institute Department of Neurosurgery; ³Univeristy of Missouri-Kansas City School of Medicine

Objective: 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	.988
Male-Female ratio	0.877±0.66	0.875±075	.989
mRS Score	1.87±0.51	2.55±0.91	.015
Motor Deficits (%)	55.8	49.2	.559
CN Deficits (%)	87.0	62.9	.263
Midbrain (%)	22.5	25.3	.643
Pons (%)	61.6	58.02	.659
Medulla (%)	14.0	19.4	.387
Size of Major Diameter (mm)	15.96±4.45	18.4±4.93	.172

Post-operative outcomes in BSCM in DTI/DTT and MRI/CT cohorts.

Variable	DTI/DTT	MRI/CT	P-value
Follow-up (months)	92.02±107.8	133.9±114.2	.184
GTR (%)	94.9±5.09	87.0±25.1	.025
Improved (%)	71.5±22.4	65.6±25.5	.343
Worse (%)	5.1±9.7	11.4±15.6	.038
Complications (%)	45.0	36.1	.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	.3430
Male to Female Ratio	-0.2487	1.6799	.8895
Motor Deficits	-0.1669	0.2716	.5722
CN neuropathy	0.6930	0.2554	.0534
Midbrain	-1.2540	0.5673	.0916
Pons	0.1803	0.2430	.4994
Medulla	-1.3769	0.4141	.0293

 

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