Surgical treatment of high-grade gliomas in motor areas. The impact of different supportive technologies: a 171-patient series.
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.
Talacchi
Andrea
A
Department of Neurological Sciences and Vision, University Hospital, Verona, Italy. andrea.talacchi@univr.it
Turazzi
Sergio
S
Locatelli
Francesca
F
Sala
Francesco
F
Beltramello
Alberto
A
Alessandrini
Franco
F
Manganotti
Paolo
P
Lanteri
Paola
P
Gambin
Roberta
R
Ganau
Mario
M
Tramontano
Vincenzo
V
Santini
Barbara
B
Gerosa
Massimo
M
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
D010100:Oxygen
Neurosurgery. 2004 May;54(5):1061-70; discussion 1070-2
15113459
Acta Neurochir (Wien). 2000;142(7):739-50
10955668
J Neurosurg. 2000 Apr;92(4):589-98
10761647
J Neurosurg. 2009 Jan;110(1):156-62
18847342
J Neurosurg. 2005 Dec;103(6):1010-7
16381187
J Neurosurg. 2003 Jun;98(6):1175-81
12816260
Minim Invasive Neurosurg. 2002 Sep;45(3):151-3
12353162
J Neurosurg. 2007 Apr;106(4):582-92
17432707
J Neurosurg. 2001 Oct;95(4):608-14
11596955
J Neurosurg. 2003 Apr;98(4):764-78
12691401
Neurosurgery. 1987 Jun;20(6):914-9
3614572
Acta Neurochir (Wien). 1992;119(1-4):23-8
1481748
Neurosurgery. 2008 Mar;62(3):564-76; discussion 564-76
18425006
Mayo Clin Proc. 1987 Jun;62(6):450-9
3553757
Cancer. 1994 Sep 15;74(6):1784-91
8082081
Neurology. 1988 Sep;38(9):1374-9
3412585
J Neurosurg. 2005 Apr;102(4):664-72
15871509
Clin Neurosurg. 1995;42:437-52
8846609
J Neurosurg. 2003 Sep;99(3):467-73
12959431
Am J Clin Oncol. 2004 Apr;27(2):195-204
15057161
Semin Oncol. 2004 Oct;31(5):659-65
15497119
Eur J Cancer. 2006 Mar;42(5):582-8
16427778
Neurosurgery. 1996 May;38(5):962-70
8727822
J Neurol Neurosurg Psychiatry. 2005 Jun;76(6):845-51
15897509
Lancet Oncol. 2006 May;7(5):392-401
16648043
J Neurosurg Sci. 2003 Jun;47(2):79-88
14618135
J Neurosurg. 1987 Aug;67(2):210-9
3298567
Neurosurgery. 1996 Apr;38(4):678-84; discussion 684-5
8692384
Minim Invasive Neurosurg. 2003 Apr;46(2):65-71
12761674
J Neurosurg. 1993 May;78(5):767-75
8468607
J Neurosurg. 2001 Aug;95(2):190-8
11780887
Stereotact Funct Neurosurg. 1992;58(1-4):153-61
1439333
Anal Bioanal Chem. 2009 Jan;393(1):187-95
18923821
Appl Neurophysiol. 1982;45(4-5):431-7
7036879
J Neurol Neurosurg Psychiatry. 2005 Aug;76(8):1152-7
16024896
J Neurol Neurosurg Psychiatry. 1990 Jun;53(6):466-71
2166137
J Neurosurg. 2004 Mar;100(3):369-75
15035270
Neurosurgery. 1991 Sep;29(3):385-8; discussion 388-9
1833663
Neurosurgery. 1998 May;42(5):1044-55; discussion 1055-6
9588549
Mayo Clin Proc. 2001 Jul;76(7):677-87
11444399
Neurosurgery. 2004 Oct;55(4):904-14; discusssion 914-5
15458599