Abstract
BackgroundTo date, few parameters have been found that can aid in patient selection and surgical strategy for eloquent area gliomas.AimsThe aim of the study was to analyze preoperative and intraoperative factors that can predict functional outcome and extent of resection in eloquent area tumors.Patients and MethodsA retrospective analysis was conducted on 60 patients harboring supratentorial gliomas in eloquent areas undergoing awake surgery. The analysis considered clinical, neuroradiologic (morphologic), intraoperative, and postoperative factors. End-points were extent of resection (EOR) as well as functional short- and long-term outcome. Postoperatively, MRI objectively established the EOR. χ2 analyses were used to evaluate parameters that could be predictive. Multivariate logistic regression analyses were used to evaluate the best combination to predict binary positive outcomes.ResultsIn 90% of the cases, subcortical stimulation was positive in the margins of the surgical cavity. Postoperatively, 51% of the patients deteriorated but 90% of the patients regained their preoperative neurological score. Factors negatively affecting EOR were volume, degree of subcortical infiltration, and presence of paresis (P<0.01). Sharp margins and cystic components were more amenable to gross total resection (P<0.01). Contrast enhancement (P<0.02), higher grade (P<0.01), paresis (P<0.01), and residual tumor in the cortex (P<0.02) negatively affected long-term functional outcomes, whereas postoperative deterioration could not be predicted for any factor other than paresis. Subcortical stimulation did not correlate with deterioration, both postoperatively (P<0.08) and at follow-up (P<0.042).ConclusionsBiological and morphological factors such as type of margins, volume, preoperative neurological status, cystic components, histology and the type of infiltration into the white matter must be considered when planning intraoperative mapping.
Highlights
Sharp margins and cystic components were more amenable to gross total resection (P,0.01)
Contrast enhancement (P,0.02), higher grade (P,0.01), paresis (P,0.01), and residual tumor in the cortex (P,0.02) negatively affected long-term functional outcomes, whereas postoperative deterioration could not be predicted for any factor other than paresis
Supratentorial gliomas are a heterogeneous group of brain tumors accounting for approximately 30% of all adult primary intracranial tumors and more than half of these are high-grade gliomas (HGGs)
Summary
Supratentorial gliomas are a heterogeneous group of brain tumors accounting for approximately 30% of all adult primary intracranial tumors and more than half of these are high-grade gliomas (HGGs). These lesions are extremely aggressive, and the vast majority of patients invariably suffer tumor recurrence, with the median survival time ranging from 1 to 3 years after initial diagnosis. For high-grade gliomas, the extent of resection (EOR) is a largely accepted parameter that significantly influence the prognosis both in terms of overall survival and progression free survival [4,5,6]. Few parameters have been found that can aid in patient selection and surgical strategy for eloquent area gliomas
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
