510 nTMS-Based Tractography, Clinical and Robotic Upper-Limb Assessment After Brain Tumor Resection: A Longitudinal Case Series and Study Design Considerations in Neuro-Oncology

INTRODUCTION: Brain tumors represent a significant health challenge, with over 300,000 new cases reported worldwide annually. Recent advancements in diagnostic imaging and specialized therapeutic interventions have improved the survival rates and life expectancy for individuals affected by brain tumors, resulting in an increased prevalence of survivors living with disabilities. Consequently, there is a pressing need for further investment in research to understand neuroplasticity during recovery, develop innovative strategies to reduce neurological impairments, enhance rehabilitation techniques, and ultimately improve the quality of life for this expanding patient population. METHODS: The report followed the Preferred Reporting Case Series in Surgery (PROCESS) Guidelines. After resection, patients were followed up with assessments of motor excitability using navigated transcranial magnetic stimulation (nTMS), nTMS-based tractography, and both functional (Fugl-Meyer scale-FM) and robotic-assisted (ARMEO Spring) evaluations of upper limb function at 30 and 90 days after brain tumor resection. RESULTS: The participants' ages were 26, 37 and 34 years old. The patients demonstrate the clinical diversity encountered in a specialized healthcare setting and highlight critical questions in study design relevant to brain tumor research. From 30 to 90 days post-BTR, participant 1 showed a decrease in rMT associated with a decrease in FM scores, while participants 2 and 3 presented a decrease in rMT. CONCLUSIONS: To our knowledge, this constitutes the first series that integrates these specific outcome measures in the evaluation of brain tumor patients. We discuss the nuances of designing studies for this unique patient population in the postoperative setting, aiming to inform future research that could lead to improved patient outcomes.