Comprehensive Analysis of Motor Deficits after Glioma Surgery having Integrated Exoscopic Neuronavigation, fMRI and DTI at Punjab Institute of Neurosciences, Lahore

Authors

  • Bakht Nawaz Neurosurgery Unit 2, Punjab Institute of Neurosciences, Lahore General Hospital, Lahore, Pakistan
  • Syed Shahzad Hussain Shah Neurosurgery Unit 2, Punjab Institute of Neurosciences, Lahore General Hospital, Lahore, Pakistan
  • Hamza Noman Neurosurgery Unit 2, Punjab Institute of Neurosciences, Lahore General Hospital, Lahore, Pakistan
  • Adeeb Ul Hassan Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
  • Hassan Ali Khosa Neurosurgery Unit 2, Punjab Institute of Neurosciences, Lahore General Hospital, Lahore, Pakistan
  • Usman Ahmad Neurosurgery Unit 2, Punjab Institute of Neurosciences, Lahore General Hospital, Lahore, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v3i7.1688

Keywords:

MRC Power Scale, Gliomas, fMRI, DTI

Abstract

Objective: To determine the frequency of motor deficits following glioma surgery using integrated exoscopic neuro-navigation, fMRI, and DTI, assessed by the MRC power scale at a tertiary care hospital in Lahore. Study Design: Descriptive longitudinal study. Study place & Duration: Department of Neurosurgery unit 2, Punjab Institute of Neurosciences, Lahore from March 25, 2025 to June 25, 2025. Methodology: A total of 64 patients were enrolled and their demographics were recorded. Following admission, baseline investigations and necessary preoperative workup were conducted. Functional MRI and Diffusion Tensor Imaging were performed. After obtaining anesthesia clearance, patients were scheduled for elective surgery in the neurosurgery operating theater. Surgeries were carried out by the neurosurgical team under neuronavigation guidance, with careful attention to preserving critical tracts and motor eloquent areas. On the first postoperative day, motor power was evaluated using the Medical Research Council (MRC) power scale. Results: The mean age of the patients was 31.20 ± 8.99 years. There were 30 (46.9%) male and 34 (53.1%) female patients. The mean MRC score on the first day was 4.75 ± 0.73, which improved to 4.87 ± 0.57 by the end of the first month. On the 1st month follow-up, motor deficit was observed in 4 (6.25%) patients glioma surgery with integrated exoscopic neuro-navigation, fMRI, and DTI. Conclusion: It was concluded that the chances of motor deficits by using the MRC power scale after glioma surgery.

Downloads

Download data is not yet available.

References

1. Bruce M Lo. Brain Neoplasms. 2022 [updated Jun; cited 2025];

https://emedicine.medscape.com/article/779664-overview.

2. Brown TJ, Brennan MC, Li M, Church EW, Brandmeir NJ, Rakszawski KL, et al. Association of the Extent of Resection With Survival in Glioblastoma: A Systematic Review and Meta-analysis. JAMA Oncol. 2016 Nov 1;2(11):1460-9.

https://doi.org/10.001/jamaoncol.2016.1373.

3. Cahill DP. Extent of Resection of Glioblastoma: A Critical Evaluation in the Molecular Era. Neurosurg Clin N Am. 2021 Jan;32(1):23-9.

https://doi.org/10.1016/j.nec.2020.09.006.

4. E Frost D, V Nahed B. Low Grade Gliomas. 2014 [cited 2026];

https://pubmed.ncbi.nlm.nih.gov/24664484

5. Duffau H. Functional Mapping before and after Low-Grade Glioma Surgery: A New Way to Decipher Various Spatiotemporal Patterns of Individual Neuroplastic Potential in Brain Tumor Patients. Cancers (Basel). 2020 Sep 13;12(9):

https://doi.org/10.3390/cancers12092611.

6. Dubey A, Kataria R, Sinha VD. Role of Diffusion Tensor Imaging in Brain Tumor Surgery. Asian J Neurosurg. 2018 Apr-Jun;13(2):302-6.

https://doi.org/10.4103/ajns.AJNS_226_16.

7. Tim Julian Hartung, Frederik Bartels, Joseph Kuchling, Stephan Krohn. MRI findings in autoimmune encephalitis. Revue Neurologique. 2024 Mar:

https://doi.org/10.1016/j.neurol.2024.08.006.

8. Conti Nibali M, Rossi M, Sciortino T, Riva M, Gay LG, Pessina F, et al. Preoperative surgical planning of glioma: limitations and reliability of fMRI and DTI tractography. J Neurosurg Sci. 2019 Apr;63(2):127-34.

https://doi.org/10.23736/S0390-5616.18.04597-6.

9. Krieg SM, Shiban E, Buchmann N, Gempt J, Foerschler A, Meyer B, et al. Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. J Neurosurg. 2012 May;116(5):994-1001.

https://doi.org/10.3171/2011.12.JNS111524.

10. Spetzger U, Laborde G, Gilsbach JM. Frameless neuronavigation in modern neurosurgery. Minim Invasive Neurosurg. 1995 Dec;38(4):163-6.

https://doi.org/10.1055/s-2008-1053478.

11. Irshad HA, Rizvi SBA, Bajwa MH, Khalid MU, Shah MM, Enam SA. Epidemiology of glioblastoma in Pakistan: a secondary analysis of the Pakistan Brain Tumor Epidemiology Study (PBTES). J Neurooncol. 2025 Jan;171(2):455-62.

https://doi.org/10.1007/s11060-024-04872-3.

12. Shams B, Wang Z, Roine T, Aydogan DB, Vajkoczy P, Lippert C, et al. Machine learning-based prediction of motor status in glioma patients using diffusion MRI metrics along the corticospinal tract. Brain Commun. 2022;4(3):fcac141.

https://doi.org/10.1093/braincomms/fcac141.

13. Weller M, Wick W, Aldape K, Brada M, Berger M, Pfister SM, et al. Glioma. Nat Rev Dis Primers. 2015 Jul 16;1:15017.

https://doi.org/10.1038/nrdp.2015.17.

14. Cai K, Han D, Deng D, Ke M, Peng M, Lyu J, et al. Analysis of Prognostic Factors of Low-Grade Gliomas in Adults Using Time-Dependent Competing Risk Models: A Population Study Based on the Surveillance, Epidemiology, and End Results Database. Cancer Control. 2022 Jan-Dec;29:10732748221143388.

https://doi.org/10.1177/.

15. Magill ST, Han SJ, Li J, Berger MS. Resection of primary motor cortex tumors: feasibility and surgical outcomes. J Neurosurg. 2018 Oct;129(4):961-72.

https://doi.org/10.3171/2017.5.JNS163045.

16. Mamani R, Jacobo JA, Guinto-Nishimura GY, Hernández-Hernández A, Moreno-Jimenez S. Motor outcome after resective surgery for the central lobe gliomas. Surg Neurol Int. 2022;13:325.

https://doi.org/10.25259/SNI_363_2022.

17. Keles GE, Lundin DA, Lamborn KR, Chang EF, Ojemann G, Berger MS. Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients. J Neurosurg. 2004 Mar;100(3):369-75.

https://doi.org/10.3171/jns.2004.100.3.0369.

18. Luzzi S, Giotta Lucifero A, Martinelli A, Maestro MD, Savioli G, Simoncelli A, et al. Supratentorial high-grade gliomas: maximal safe anatomical resection guided by augmented reality high-definition fiber tractography and fluorescein. Neurosurg Focus. 2021 Aug;51(2):E5.

https://doi.org/10.3171/2021.5.FOCUS21185.

19. Gong F, Jin L, Song Q, Yang Z, Chen H, Wu J. Surgical techniques and function outcome for cingulate gyrus glioma, how we do it. Front Oncol. 2022;12:986387.

https://doi.org/10.3389/fonc.2022.

Downloads

Published

2025-07-15

How to Cite

Nawaz, B., Shah, S. S. H., Noman, H., Adeeb Ul Hassan, Khosa, H. A. K., & Usman Ahmad. (2025). Comprehensive Analysis of Motor Deficits after Glioma Surgery having Integrated Exoscopic Neuronavigation, fMRI and DTI at Punjab Institute of Neurosciences, Lahore. Indus Journal of Bioscience Research, 3(7), 381-385. https://doi.org/10.70749/ijbr.v3i7.1688