Radiological features of peritumoral brain injury and neurological outcomes after glioma surgery: a prospective observational study.

PURPOSE: Despite significant advances in glioma surgery, early postoperative neuroimaging frequently reveals signs of surgical brain injury (SBI). This prospective observational study aimed to investigate the incidence, radiological characteristics, neurological outcomes and risk factors of SBI following glioma resection.

METHODS

Patients with newly diagnosed supratentorial gliomas who undergo tumor resection were prospectively enrolled. Serial MRI examinations were administrated early postoperative (≤ 72 h) and on postoperative days 7, 14 and 28 to assess the characteristics of infarction, edema and microhemorrhage. Neurological outcomes were evaluated using the modified Rankin Scale (mRS) at postoperative day 28.

RESULTS

A total of 64 patients was included. Postoperative infarction was identified in 14 patients (21.9%), with all anatomically localized to the basal ganglia, thalamus, or insular regions. Intraoperative blood loss ≥ 300 mL was independently associated with postoperative infarction (Odd Ratio [OR]: 4.62, p = 0.035). Microhemorrhage was observed in 53.8% of patients. Peritumoral edema occurred in all cases and exhibited two distinct patterns: residual tumor-associated edema (n = 42) and de novo surgery-induced edema (n = 22). The average volume of tumor-associated edema decreased, whereas that of surgery-induced edema increased over time. Among the 53 patients who completed neurological outcome assessments, 13 developed disability (mRS ≥ 2). Risk factors were higher intraoperative blood loss (OR: 8.88, p = 0.013) and postoperative infarction (OR: 6.33, p = 0.031).

CONCLUSION

SBI, including infarction and edema, is common following glioma surgery and associated with adverse neurological outcomes. Meticulous intraoperative hemostatic management is essential to prevent postoperative infarction and even disability outcome.