Surgical Strategies of frontal, temporal, and occipital lobe gliomas in non-functional areas

Abstract

Objective To summarize the clinical characteristics and surgical treatment strategies of frontal, temporal, and occipital lobe gliomas in non-functional areas. Methods From January 2009 to January 2013, the clinical data of 89 patients with glioma who had complete data and whose lesions located in frontal, temporal, and occipital lobe non-functional areas treated in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. The corresponding surgical strategies were selected according to preoperative imaging showed the location and size of the tumors and edema degree. The tumor tissues were maximally removed. Routine use of navigation and B-ultrasound localization during the operation, the gliomas were removed by using the yellow fluorescence microscope-assisted resection. Results In 89 patients, the lesions of 49 patients were confined to the cortices, 11 were confined to the deep brain ventricles, and 29 invaded the ventricles and cortices at the same time. The lesions of 67 patients were confined to one lobe and 22 invaded a plurality of lobes. The postoperative pathology confirmed that the tumors of 12 patients were WHO grade I, 21 were WHO grade II, 29 were WHO grade III, and 27 were WHO grade IV. The postoperative MRI confirmed that 74 patients (83.1%) had total resection, 11 (12.4%) had subtotal resection, and 2 (2.2%) had near-total resection, and 2 (2.2%) had partial resection. The mean follow-up time after procedure was 30.0+ 3.6 months. The 2-year survival rate of WHO grade Ⅲ was 51.7% and that of WHO grade Ⅳ was 33.3%. Forty-one patients died during the follow-up period, including 21 (77.8%) with WHO grade IV, and their median survival time was 19.4 (11.5-30.2) months; 18 (62.1%) with WHO grade III, and their median survival time was 26.7 (19.7-36.5) months; 2 (9.5%) with WHO grade II, and none of them with WHO grade I died. Conclusion Under the guidance of the imaging, the surgical methods and resection range of frontal, temporal, or occipital lobe gliomas are helpful to improve the total resection rate and survival time of the patients.. Key words: Glioma; Frontal lobe; Temporal lobe; Occipital lobe; Neurosurgical proce-dures; Non-functional areas