title: Surgical treatment of high-grade gliomas in motor areas. The impact of different supportive technologies: a 171-patient series.
abstract: In the last few years much has been published to validate new technology in brain mapping for clinical purposes, but there have been few clinical results. In this report we describe our five-year experience in the surgical management of malignant gliomas around motor areas with an evaluation of the impact of functional magnetic resonance imaging (fMRI) plus navigator and intraoperative neurophysiology (IN). End-points were extent of removal, morbidity, and survival. Variables describing patient and tumor characteristics and treatment modalities were statistically weighted in relation to treatment outcome. Tumor depth (P = 0.01), midline shift ≥1 cm. (P = 0.05), and insular location (P = 0.001) negatively affected extent of removal, whereas IN (P < 0.001) and fMRI plus navigator (P = 0.02) contributed to increasing the rate of total removal (73%, 71% vs. 40%). Postoperative motor impairment was mild and transient in a minority of cases (20%). General complications, as defined by the Glioma Outcome Project, occurred in 23% of cases. IN was the only factor associated with acute postoperative motor deterioration (P < 0.001). IN and age >65 years (P = 0.01) were associated with the occurrence of complications. Overall survival was significantly higher in patients operated with IN or fMRI plus navigator (P < 0.01). Comparing different surgical strategies used in the same period, we observed that supportive technologies in glioma surgery have their primary impact on the quality of resection and survival. IN led to transient motor impairment and some additional complications which did not affect functional outcome.
authors.affiliation: Department of Neurological Sciences and Vision, University Hospital, Verona, Italy. andrea.talacchi@univr.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Talacchi
authors.forename: Sergio
authors.initials: S
authors.lastname: Turazzi
authors.forename: Francesca
authors.initials: F
authors.lastname: Locatelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Sala
authors.forename: Alberto
authors.initials: A
authors.lastname: Beltramello
authors.forename: Franco
authors.initials: F
authors.lastname: Alessandrini
authors.forename: Paolo
authors.initials: P
authors.lastname: Manganotti
authors.forename: Paola
authors.initials: P
authors.lastname: Lanteri
authors.forename: Roberta
authors.initials: R
authors.lastname: Gambin
authors.forename: Mario
authors.initials: M
authors.lastname: Ganau
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tramontano
authors.forename: Barbara
authors.initials: B
authors.lastname: Santini
authors.forename: Massimo
authors.initials: M
authors.lastname: Gerosa
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007432:Intraoperative Period; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000098:blood supply / Q000601:surgery*; D009069:Movement Disorders / Q000209:etiology*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D016017:Odds Ratio; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
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