Resection versus biopsy of glioblastomas in eloquent brain areas.
OBJECTIVE
The aim of this study was to compare resection and biopsy of glioblastoma (GBM) in eloquent brain areas (EBA).


METHODS
This was a prospective evaluation of 38 patients with GBM in EBA. 22 were treated by surgical resection and 16 by biopsy. Preoperative KPS, neurological status and size of lesion on MRI were assessed. One week and three months postoperatively KPS, neurological status and Performance Status (PS) WHO were evaluated. Extent of resection (EOR) and overall survival (OS) were described. Overall mean age of the patients was 64.3 years, the mean lesion size in the resection group was 47.7 mm and in the biopsy group 51.0 mm.


RESULTS
Worsening or development of permanent neurological deficits 3 months after surgery were significantly lower in the resection group (23%), than the biopsy group (94%). In the resection group the median pre and postoperative KPS three months after surgery was 80.0. In the biopsy group the median pre and postoperative KPS was 68.1 one week after the procedure. In the resection group, 3 months after surgery, the median PS was 1, in the biopsy group one week after surgery the median PS was 2. The difference was statistically insignificant. The mean OS after resection was 12.2 months, and after biopsy 3.5 months. The difference was highly statistically significant. The mean EOR was 90%.


CONCLUSIONS
This is the first prospective study, to our knowledge, that compares the results of resection and biopsy of primary GBM in EBA. For patients in good clinical condition with tumors in or near EBA, recommended is as radical resection of GBM as possible.
Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
Lumir
L
Hrabalek
Ondrej
O
Kalita
Miroslav
M
Vaverka
Miloslava
M
Zlevorova
Jiri
J
Ehrmann
Eva
E
Cechakova
Milan
M
Adamus
Vlastimil
V
Novak
Katerina
K
Langova
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D001921:Brain / Q000473:pathology* / Q000601:surgery; D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies