Benefits of glioma resection in the corpus callosum

Marie-Therese Forster,Martin Voss,Christian Senft,Volker Seifert,Nadine Conradi,Irina Lortz,Marion Behrens,Maximilian Rauch

doi:10.1038/s41598-020-73928-x

Marie-Therese Forster, Martin Voss + Show 6 more

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https://doi.org/10.1038/s41598-020-73928-x

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Abstract

Due to anticipated postoperative neuropsychological sequelae, patients with gliomas infiltrating the corpus callosum rarely undergo tumor resection and mostly present in a poor neurological state. We aimed at investigating the benefit of glioma resection in the corpus callosum, hypothesizing neuropsychological deficits were mainly caused by tumor presence. Between 01/2017 and 1/2020, 21 patients who underwent glioma resection in the corpus callosum were prospectively enrolled into this study. Neuropsychological function was assessed preoperatively, before discharge and after 6 months. Gross total tumor resection was possible in 15 patients, and in 6 patients subtotal tumor resection with a tumor reduction of 97.7% could be achieved. During a median observation time of 12.6 months 9 patients died from glioblastoma after a median of 17 months. Preoperatively, all cognitive domains were affected in up to two thirds of patients, who presented a median KPS of 100% (range 60–100%). After surgery, the proportion of impaired patients increased in all neurocognitive domains. Most interestingly, after 6 months, significantly fewer patients showed impairments in attention, executive functioning, memory and depression, which are domains considered crucial for everyday functionality. Thus, the results of our study strongly support our hypothesis that in patients with gliomas infiltrating the corpus callosum the benefit of tumor resection might outweigh morbidity.

Highlights

Due to anticipated postoperative neuropsychological sequelae, patients with gliomas infiltrating the corpus callosum rarely undergo tumor resection and mostly present in a poor neurological state
Tumor location was frontal in 20 patients and parietal in 1 patient, with corpus callosum invasion of different degrees, including 2 huge butterfly gliomas and further 6 tumors involving both hemispheres, and with additional involvement of the cingulate gyrus in 11 patients
Tumor resection was complete in 15 patients, and subtotal in 6 patients, with median residual tumor volume of 2.1 c m3 and median extent of surgical tumor resection (EoR) reaching 97.7% in these 6 patients (Fig. 1)

Summary

Introduction

Due to anticipated postoperative neuropsychological sequelae, patients with gliomas infiltrating the corpus callosum rarely undergo tumor resection and mostly present in a poor neurological state. We observed many patients with huge frontal glioma and corpus callosum invasion who presented with avolition, aboulia or impaired consciousness already at the time of diagnosis, and many of these patients died within a few months after tumor biopsy and despite radiochemotherapy. This led us to hypothesize that tumor

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