Re-operation is a safe and effective therapeutic strategy in recurrent WHO grade II gliomas within eloquent areas

Abstract

To analyze the functional and oncological results after re-operation for recurrent WHO grade II Glioma located in eloquent regions. We reviewed a consecutive series of 19 patients with GIIG within functional areas who underwent two operations separated by at least 1 year. Intraoperative electrical stimulation mapping was used in all operations for recurrence and in 14 of the initial procedures. A specific rehabilitation was provided. At the first operation, we performed 14 subtotal and 5 partial resections. Eighteen patients returned to a normal socio-professional life. Nine patients received adjuvant treatment. At the second operation, we performed 1 total, 13 subtotal and 5 partial resections. Three patients with a preoperative neurological deficit improved, 13 remained unchanged, and 3 slight new deficits appeared. In 14 of the 17 patients with preoperative chronic epilepsy, the seizures were reduced or disappeared. Sixteen patients returned to a normal socio-professional life. Pathohistological examination showed that 11 tumours had progressed to high-grade glioma. The median time between the two operations was 4.1 years (range 1 to 7.8 years) and the median follow-up from initial diagnosis was 6.6 years (range 2.3 to 14.3 years). No deaths occurred during the follow-up period. Repeat operations guided by intra-operative electrical stimulation is an efficacious treatment for recurrent grade II glioma in an eloquent area.