Motor Recovery in Glioma Patients After Craniotomy: A Case Study of Continuous Rehabilitation Assessed With Diffusion Tensor Imaging

Motor function deterioration is a common postoperative complication in glioma patients, affecting daily activities. Although continuous rehabilitation is essential for motor recovery, the underlying cause of postoperative decline remains unclear. This case study investigates the temporal relationship between motor function, corticospinal tract (CST) fractional anisotropy (FA), and edema in a glioma patient following awake craniotomy. A 43-year-old Japanese man with recurrent left parietal glioma and right spastic hemiparesis underwent seven tumor resections over 12 years, culminating in an awake craniotomy. He experienced postoperative motor decline and underwent continuous rehabilitation. FA values of the CST and motor function were assessed preoperatively and on postoperative days 12, 29, and 134. Magnetic resonance imaging (MRI), T2 fluid-attenuated inversion recovery (FLAIR) was used to monitor edema progression. On postoperative day 12, a significant increase in edema was observed in the frontoparietal region, coinciding with a decline in FA and motor function. However, by postoperative days 29 and 134, edema had decreased, and both FA and motor function improved. The findings suggest that vasogenic edema contributed to the transient motor decline, as evidenced by the reversible FA changes, suggesting that CST integrity assessment via FA and edema monitoring may guide postoperative rehabilitation strategies.