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Surgery of highly eloquent gliomas primarily assessed as non-resectable: risks and benefits in a cohort study
BACKGROUND: Today, the treatment of choice for high- and low-grade gliomas requires primarily surgical resection to achieve the best survival and quality of life. Nevertheless, many gliomas within highly eloquent cortical regions, e.g., insula, rolandic, and left perisylvian cortex, still do not und...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583679/ https://www.ncbi.nlm.nih.gov/pubmed/23374675 http://dx.doi.org/10.1186/1471-2407-13-51 |
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author | Krieg, Sandro M Schnurbus, Lea Shiban, Ehab Droese, Doris Obermueller, Thomas Buchmann, Niels Gempt, Jens Meyer, Bernhard Ringel, Florian |
author_facet | Krieg, Sandro M Schnurbus, Lea Shiban, Ehab Droese, Doris Obermueller, Thomas Buchmann, Niels Gempt, Jens Meyer, Bernhard Ringel, Florian |
author_sort | Krieg, Sandro M |
collection | PubMed |
description | BACKGROUND: Today, the treatment of choice for high- and low-grade gliomas requires primarily surgical resection to achieve the best survival and quality of life. Nevertheless, many gliomas within highly eloquent cortical regions, e.g., insula, rolandic, and left perisylvian cortex, still do not undergo surgery because of the impending risk of surgery-related deficits at some centers. However, pre and intraoperative brain mapping, intraoperative neuromonitoring (IOM), and awake surgery increase safety, which allows resection of most of these tumors with a considerably low rate of postoperatively new deficits. METHODS: Between 2006 and 2012, we resected 47 out of 51 supratentorial gliomas (92%), which were primarily evaluated to be non-resectable during previous presentation at another neurosurgical department. Out of these, 25 were glioblastomas WHO grade IV (53%), 14 were anaplastic astrocytomas WHO grade III (30%), 7 were diffuse astrocytomas WHO grade II (15%), and one was a pilocytic astrocytoma WHO grade I (2%). All data, including pre and intraoperative brain mapping and monitoring (IOM) by motor evoked potentials (MEPs) were reviewed and related to the postoperative outcome. RESULTS: Awake surgery was performed in 8 cases (17%). IOM was required in 38 cases (81%) and was stable in 18 cases (47%), whereas MEPs changed the surgical strategy in 10 cases (26%). Thereby, gross total resection was achieved in 35 cases (74%). Postoperatively, 17 of 47 patients (36%) had a new motor or language deficit, which remained permanent in 8.5% (4 patients). Progression-free follow-up was 11.3 months (range: 2 weeks – 64.5 months) and median survival was 14.8 months (range: 4 weeks – 20.5 months). Median Karnofsky Performance Scale was 85 before and 80 after surgery). CONCLUSIONS: In specialized centers, most highly eloquent gliomas are eligible for surgical resection with an acceptable rate of surgery-related deficits; therefore, they should be referred to specialized centers. |
format | Online Article Text |
id | pubmed-3583679 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-35836792013-02-28 Surgery of highly eloquent gliomas primarily assessed as non-resectable: risks and benefits in a cohort study Krieg, Sandro M Schnurbus, Lea Shiban, Ehab Droese, Doris Obermueller, Thomas Buchmann, Niels Gempt, Jens Meyer, Bernhard Ringel, Florian BMC Cancer Research Article BACKGROUND: Today, the treatment of choice for high- and low-grade gliomas requires primarily surgical resection to achieve the best survival and quality of life. Nevertheless, many gliomas within highly eloquent cortical regions, e.g., insula, rolandic, and left perisylvian cortex, still do not undergo surgery because of the impending risk of surgery-related deficits at some centers. However, pre and intraoperative brain mapping, intraoperative neuromonitoring (IOM), and awake surgery increase safety, which allows resection of most of these tumors with a considerably low rate of postoperatively new deficits. METHODS: Between 2006 and 2012, we resected 47 out of 51 supratentorial gliomas (92%), which were primarily evaluated to be non-resectable during previous presentation at another neurosurgical department. Out of these, 25 were glioblastomas WHO grade IV (53%), 14 were anaplastic astrocytomas WHO grade III (30%), 7 were diffuse astrocytomas WHO grade II (15%), and one was a pilocytic astrocytoma WHO grade I (2%). All data, including pre and intraoperative brain mapping and monitoring (IOM) by motor evoked potentials (MEPs) were reviewed and related to the postoperative outcome. RESULTS: Awake surgery was performed in 8 cases (17%). IOM was required in 38 cases (81%) and was stable in 18 cases (47%), whereas MEPs changed the surgical strategy in 10 cases (26%). Thereby, gross total resection was achieved in 35 cases (74%). Postoperatively, 17 of 47 patients (36%) had a new motor or language deficit, which remained permanent in 8.5% (4 patients). Progression-free follow-up was 11.3 months (range: 2 weeks – 64.5 months) and median survival was 14.8 months (range: 4 weeks – 20.5 months). Median Karnofsky Performance Scale was 85 before and 80 after surgery). CONCLUSIONS: In specialized centers, most highly eloquent gliomas are eligible for surgical resection with an acceptable rate of surgery-related deficits; therefore, they should be referred to specialized centers. BioMed Central 2013-02-02 /pmc/articles/PMC3583679/ /pubmed/23374675 http://dx.doi.org/10.1186/1471-2407-13-51 Text en Copyright ©2013 Krieg et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Krieg, Sandro M Schnurbus, Lea Shiban, Ehab Droese, Doris Obermueller, Thomas Buchmann, Niels Gempt, Jens Meyer, Bernhard Ringel, Florian Surgery of highly eloquent gliomas primarily assessed as non-resectable: risks and benefits in a cohort study |
title | Surgery of highly eloquent gliomas primarily assessed as non-resectable: risks and benefits in a cohort study |
title_full | Surgery of highly eloquent gliomas primarily assessed as non-resectable: risks and benefits in a cohort study |
title_fullStr | Surgery of highly eloquent gliomas primarily assessed as non-resectable: risks and benefits in a cohort study |
title_full_unstemmed | Surgery of highly eloquent gliomas primarily assessed as non-resectable: risks and benefits in a cohort study |
title_short | Surgery of highly eloquent gliomas primarily assessed as non-resectable: risks and benefits in a cohort study |
title_sort | surgery of highly eloquent gliomas primarily assessed as non-resectable: risks and benefits in a cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583679/ https://www.ncbi.nlm.nih.gov/pubmed/23374675 http://dx.doi.org/10.1186/1471-2407-13-51 |
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