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Background <p>The infiltration of the corticospinal tract (CST) in patients with gliomas may lead to more postoperative paralysis and worse survival than others. The aim of this study is to investigate the clinical outcomes and propose the surgical strategy for these patients.</p> Methods <p>We retrospectively identified 101 patients with CST infiltrated by cerebral gliomas on preoperative DTI tractography. Surgical, neurologic, and oncological outcomes were assessed on long-term follow-up.</p> Results <p>Forty-eight (47.5%) patients harbored grade II gliomas, 26 (25.7%) had grade III gliomas, and 27 (26.7%) had grade IV gliomas. Gross-total resection (GTR) or subtotal resection (STR) was achieved in 67.3% of patients, and partial resection (PR) was achieved in 32.7% of patients. Large tumors (≥&#xa0;24.5&#xa0;ml) and low-grade gliomas (LGGs) were independent prognostic factors for partial resection. Patients with high-grade gliomas (HGGs) and pre-operative motor deficit had a higher risk for permanent paralysis. Thirty-three of 101 patients (32.7%) had long-term paralysis, and 7 patients (6.9%) suffered from severe paralysis. The median PFS and OS were 12&#xa0;months and 24&#xa0;months in grade IV gliomas. In multivariate analysis using the Cox model, low tumor grade and IDH1 mutation were independent factors for longer PFS, and low tumor grade was an independent factor for longer OS.</p> Conclusion <p>Preoperative DTI tractography is a valuable tool for determining the extent of CST involvement in patients with gliomas. The risk of postoperative paralysis is extremely high; therefore, careful and conservative resection should be performed to preserve motor function. Despite this challenge, patients can still achieve positive oncological outcomes with standard adjuvant therapy after surgery.</p>

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Long-term clinical prognosis of patients with gliomas infiltrating corticospinal tract on DTI tractography

  • 期刊论文

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  • 发表日期：

    2025年10月24日

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  • Xijie Wang,
  • Zhentao Zuo,
  • Songlin Yu,
  • Song Lin,
  • Tao Yu

摘要

Background

The infiltration of the corticospinal tract (CST) in patients with gliomas may lead to more postoperative paralysis and worse survival than others. The aim of this study is to investigate the clinical outcomes and propose the surgical strategy for these patients.

Methods

We retrospectively identified 101 patients with CST infiltrated by cerebral gliomas on preoperative DTI tractography. Surgical, neurologic, and oncological outcomes were assessed on long-term follow-up.

Results

Forty-eight (47.5%) patients harbored grade II gliomas, 26 (25.7%) had grade III gliomas, and 27 (26.7%) had grade IV gliomas. Gross-total resection (GTR) or subtotal resection (STR) was achieved in 67.3% of patients, and partial resection (PR) was achieved in 32.7% of patients. Large tumors (≥ 24.5 ml) and low-grade gliomas (LGGs) were independent prognostic factors for partial resection. Patients with high-grade gliomas (HGGs) and pre-operative motor deficit had a higher risk for permanent paralysis. Thirty-three of 101 patients (32.7%) had long-term paralysis, and 7 patients (6.9%) suffered from severe paralysis. The median PFS and OS were 12 months and 24 months in grade IV gliomas. In multivariate analysis using the Cox model, low tumor grade and IDH1 mutation were independent factors for longer PFS, and low tumor grade was an independent factor for longer OS.

Conclusion

Preoperative DTI tractography is a valuable tool for determining the extent of CST involvement in patients with gliomas. The risk of postoperative paralysis is extremely high; therefore, careful and conservative resection should be performed to preserve motor function. Despite this challenge, patients can still achieve positive oncological outcomes with standard adjuvant therapy after surgery.