Assessing Postoperative Motor Risk in Insular Low‐Grade Gliomas Patients: The Potential Role of Presurgery MRI Corticospinal Tract Shape Measures

Background Insular low‐grade gliomas (LGGs) are surgically challenging due to their proximity to critical structures like the corticospinal tract (CST). Purpose This study aims to determine if preoperative CST shape metrics correlate with postoperative motor complications in insular LGG patients. Study Type Retrospective. Population 42 patients (mean age 40.26 ± 10.21 years, 25 male) with insular LGGs. Field Strength/Sequence Imaging was performed using 3.0 Tesla MRI, incorporating T1‐weighted magnetization‐prepared rapid gradient‐echo, T2‐weighted space dark‐fluid with spin echo (SE), and diffusional kurtosis imaging (DKI) with gradient echo sequences, all integrated with echo planar imaging. Assessment Shape metrics of the CST, including span, irregularity, radius, and irregularity of end regions (RER and IER, respectively), were compared between the affected and healthy hemispheres. Total end region radius (TRER) was determined as the sum of RER 1 and RER 2. The relationships between shape metrics and postoperative short‐term (4 weeks) and long‐term (>8 weeks) motor disturbances assessing by British Medical Research Council grading system, was analyzed using multivariable regression models. Statistical Testing Paired t‐tests compared CST metrics between hemispheres. Logistic regression identified associations between these metrics and motor disturbances. The models were developed using all available data and there was no independent validation dataset. Significance was set at P