Evaluation of Functional Outcome Following Resection of Supratentorial Lesions at Eloquent Brain Areas

Abstract

Abstract Objectives Microsurgical management of intrinsic brain tumors aims to maximize the extent of resection and to minimize the postoperative morbidity. The purpose of this study is to evaluate the functional outcome following surgical excision of supratentorial lesions at eloquent brain areas such as language, motor and sensory cortex, regarding the extent of resection, the karnofsky performance scale, the neurological deficit and seizure control. Methods A prospective study of 25 patients aged 15-55 years, 15 females and 10 males underwent surgical excision of supra-tentorial lesions at eloquent brain, The Karnofsky Performance Score (KPS), seizure attacks and neurological deficits were analyzed before and after resection. Functional resection was implemented using preoperative functional magnetic resonance image (fMRI), intraoperative image guidance and electrophysiological monitoring under total intravenous anesthesia (TIVA) or awake craniotomy and the extent of resection was quantified postoperatively. Results Preoperative median KPS was 76.8%. It improved one year post-operatively to 89.2%. One patient died 3 weeks postoperatively due to neurological, cardiac and chest complications. The pathology report revealed recurrent metastatic adenocarcinoma GIII. Preoperatively, twenty-three patients had seizure attacks, 10 were controlled and 13 were uncontrolled on medication. Postoperatively seven patients were Engels classification IC and 17 patients were controlled on anti-epileptics (Engels classification ID). Preoperatively 19 patients had hemiparesis/ hemiplegia, while immediate (one week) postoperatively 13 patients improved, 8 patients experienced initial worsening of the preoperative deficits and 4 patients had the same deficit as preoperatively while at 1-year postoperatively, 24 patients improved. Gross total resection (>95%) was achieved in 19 patients, subtotal resection (>75%) in 4 patients and partial resection (>65%) in 2 patients. Conclusion Functional resection is believed to be a key prognostic factor in supratentorial lesions at eloquent brain regarding improving of karnofsky performance scale, neurological outcome and seizure control.