The role of DTI in surgical management of brainstem cavernous malformations: A meta-analysis of 4159 cases.

BACKGROUND

Brainstem cavernous malformations (BSCMs) are challenging neurosurgical entities due to their critical location. Advanced imaging techniques like diffusion tensor imaging (DTI) have emerged as potential tools for improving surgical outcomes.

PURPOSE: To compare the efficacy and 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).

DATA SOURCES: A systematic review of studies published from 2007 to 2023 was conducted using data from Pubmed, Embase, and Scopus.

STUDY SELECTION: 106 studies involving 4159 patients with BSCM were included. Patients were stratified into two cohorts: those who received DTI/DTT (n = 382) and those who received only MRI/CT (n = 3777).

DATA ANALYSIS: Primary outcomes included gross total resection rates, clinical improvement, stability, and worsening, as well as complications. Meta-analysis was performed using a random-effects model. Multivariate regression analysis was conducted to identify factors impacting outcomes in the DTI/DTT cohort.

DATA SYNTHESIS: 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).

LIMITATIONS: The retrospective nature of most included studies introduces potential selection bias. Heterogeneity in surgical techniques, operator experience, and outcome measures across studies may impact the generalizability of findings. The relatively small number of patients in the DTI/DTT cohort compared to the MRI/CT cohort suggests that further large-scale, prospective studies are needed.

CONCLUSIONS

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. These findings suggest that DTI/DTT may be a valuable tool in improving surgical outcomes for patients with BSCM, particularly in guiding resection strategies and potentially preserving critical white matter tracts.