Functional and oncological outcomes following awake surgical resection using intraoperative cortico-subcortical functional mapping for supratentorial gliomas located in eloquent areas.
OBJECTIVE
Glioma survival correlated with the extent of resection and the functional status of the patient. We detailed functional results along with oncological results after a functional-based resection of gliomas located within eloquent regions.


METHODS
Single centre prospective series of adult patients with gliomas located within eloquent regions, treated with maximal resection according to functional boundaries using intraoperative cortico-subcortical monitoring under awake conditions, with available functional outcomes (language and cognitive assessments, neurological status, ability to work) and oncological outcomes (extent of surgical resection, survivals).


RESULTS
The series included 107 awake surgeries (45.8% grade II gliomas, 41.1% grade III gliomas, 13.1% glioblastomas) with 18.7% of preoperative focal neurological deficits, 91.6% of neuropsychological disturbances, and 61.5% of inability to work. A total of 85.7% of grade II gliomas had a resection>90% (mean 86.3±22.6%), 61.4% of grade III gliomas had a resection>90% (mean 78.7±30.4%) and 85.7% of glioblastomas had a resection>90% (mean 89.0±29.5%). Also, 85.0% of patients presented a postoperative worsening of their neurological and/or cognitive status and underwent a personalized rehabilitation. At a 6-month postoperative follow-up, 89.9% of cognitive impairments improved, 30.8% of patients with a preoperative language impairment improved (language postoperative worsening present in 1.9%), and 74.4% resumed their employment activities. The survival rate varied significantly with the extent of resection and with the grade of malignancy.


CONCLUSIONS
Maximal functional-based resection improves the onco-functional balance of adult patients harboring a glioma located within eloquent regions by increasing both the survival and the quality of life through functional improvement.
Department of Neurosurgery, Sainte-Anne Hospital, 75006 Paris, France; Paris-Descartes University, Sorbonne Paris Cité, 75006 Paris, France. Electronic address: johanpallud@hotmail.com.
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Pallud
Department of Neurosurgery, Sainte-Anne Hospital, 75006 Paris, France; Paris-Descartes University, Sorbonne Paris Cité, 75006 Paris, France.
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Dezamis
D000328:Adult; D000368:Aged; D001931:Brain Mapping; D001932:Brain Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D005910:Glioma / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology*
Awake craniotomy; Employment; Extent of resection; Functional status; Glioma; Outcomes; Surgery