SPCM-04 OUTCOMES IN DIFFUSION TENSOR IMAGING ASSISTED SURGERY FOR INTRAMEDULLARY SPINAL CORD TUMORS

Abstract INTRODUCTION Intramedullary spinal cord tumors (IMSCT) disrupt white matter tracts resulting in neurologic deficits. Diffusion tensor imaging (DTI) is a neuroimaging technique utilizing the diffusion of water to visualize white matter tracts and aid in surgical dissection. DTI implementation has resulted in improved clinical outcome in brain surgery, yet the effectiveness of DTI in metastatic and benign IMSCT surgery in unknown. OBJECTIVE To evaluate whether pre-operative DTI improves functional outcome following surgery for IMSCT. METHOD We performed a retrospective chart review on all patients who underwent DTI-assisted resection of IMSCT from 2016-2020 at a tertiary comprehensive cancer center. Patient demographics, clinical characteristics, tumor characteristics, KPS and McCormick scores were collected. RESULT 10 patients (70% male, 90% Caucasian) with an average age of 46.9 years underwent spinal surgery for the removal of benign or malignant tumors. Tumor subtypes included 3 hemangioblastomas, 3 ependymomas, 1 plasmacytoma, 2 ganglioneurocytomas, and 1 renal cell carcinoma metastasis. Surgical sites range from C1 to conus medullaris. Follow up ranged 2 weeks to 24 months. No significant changes in KPS nor McCormick scores were observed at 2-12 weeks; however, all patients had either stable or improved KPS and McCormick score at 18 months post-operative. On average, patients’ KPS increased from 71 ± 15 to 80 ± 13 (p<0.9) and their McCormick decreased from 2.9 ± 0.9 to 2.3 ± 0.5 (p<0.7), both of which indicate greater neurological function. CONCLUSION In our institutional experience, pre-operative assessment of intramedullary spinal cord tumors utilizing DTI to visualize white matter tracts yields increased neurological function as measured by both KPS and the McCormick score with a trend towards significance. These improved post-operative outcomes warrant further study into the validity of DTI in intramedullary tumor resection.