title: Association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme.
abstract: OBJECTIVE
  Balancing the benefits of extensive tumor resection with the consequence of potential postoperative deficits remains a challenge in malignant astrocytoma surgery. Although studies have suggested that increasing extent of resection may benefit survival, the effect of new postoperative deficits on survival remains unclear. We set out to determine whether new-onset postoperative motor or speech deficits were associated with survival in our institutional experience with glioblastoma multiforme (GBM).
  
  
  METHODS
  We retrospectively reviewed records of all patients (age range, 18-70 years; Karnofsky Performance Scale score, 80-100) who had undergone GBM resection between 1996 and 2006 at a single institution. Survival was compared between patients who had experienced surgically acquired motor or language deficits versus those who did not experience these deficits.
  
  
  RESULTS
  Three hundred six consecutive patients (age, 54 +/- 11 years; median Karnofsky Performance Scale score, 80) underwent primary GBM resection. Nineteen patients (6%) developed surgically acquired motor deficits and 15 (5%) developed surgically acquired language deficits. Median survival was decreased in patients who acquired language deficits (9.6 months; P < 0.05) or motor deficits (9.0 months; P < 0.05) versus patients without surgically acquired deficits (12.8 months). Two-year survival was 8% and 0% for patients with surgically acquired motor or language deficits, respectively, versus 23% for patients without new-onset deficits.
  
  
  CONCLUSIONS
  In our experience, the development of new perioperative motor or language deficits was associated with decreased overall survival despite similar extent of resection and adjuvant therapy. Although it is well known that surgically induced neurological deficits affect quality of life, our results suggest that these surgical morbidities may also affect survival. Care should be taken to avoid surgically induced deficits in the management of GBM.
authors.affiliation: Department of Neurosurgery, The Neuro-Oncology Surgical Outcomes Research Laboratory, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Debraj
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Kaisorn L
authors.initials: KL
authors.lastname: Chaichana
authors.forename: Khoi D
authors.initials: KD
authors.lastname: Than
authors.forename: Jon D
authors.initials: JD
authors.lastname: Weingart
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quinones-Hinojosa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000601:surgery; D006801:Humans; D017567:Karnofsky Performance Status; D007806:Language Disorders / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult