TY - JOUR
T1 - Surgery of Insular Diffuse Gliomas - Part 1
T2 - Transcortical Awake Resection Is Safe and Independently Improves Overall Survival
AU - Pallud, Johan
AU - Zanello, Marc
AU - Moiraghi, Alessandro
AU - Peeters, Sophie
AU - Trancart, Bénédicte
AU - Edjlali, Myriam
AU - Oppenheim, Catherine
AU - Varlet, Pascale
AU - Chrétien, Fabrice
AU - Dhermain, Frédéric
AU - Roux, Alexandre
AU - Dezamis, Edouard
N1 - Publisher Copyright:
© 2021 Congress of Neurological Surgeons 2021.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - BACKGROUND: Insular diffuse glioma resection is at risk of vascular injury and of postoperative new neurocognitive deficits. OBJECTIVE: To assess safety and efficacy of surgical management of insular diffuse gliomas. METHODS: Observational, retrospective, single-institution cohort analysis (2005-2019) of 149 adult patients surgically treated for an insular diffuse glioma: transcortical awake resection with intraoperative functional mapping (awake resection subgroup, n = 61), transcortical asleep resection without functional mapping (asleep resection subgroup, n = 50), and stereotactic biopsy (biopsy subgroup, n = 38). All cases were histopathologically assessed according to the 2016 World Health Organization classification and cIMPACT-NOW update 3. RESULTS: Following awake resection, 3/61 patients had permanent motor deficit, seizure control rates improved (89% vs 69% preoperatively, P =. 034), and neurocognitive performance improved from 5% to 24% in tested domains, despite adjuvant oncological treatments. Resection rates were higher in the awake resection subgroup (median 94%) than in the asleep resection subgroup (median 46%; P <. 001). There was more gross total resection (25% vs 12%) and less partial resection (34% vs 80%) in the awake resection subgroup than in the asleep resection subgroup (P <. 001). Karnofsky Performance Status score <70 (adjusted hazard ratio [aHR] 2.74, P =. 031), awake resection (aHR 0.21, P =. 031), isocitrate dehydrogenase (IDH)-mutant grade 2 astrocytoma (aHR 5.17, P =. 003), IDH-mutant grade 3 astrocytoma (aHR 6.11, P <. 001), IDH-mutant grade 4 astrocytoma (aHR 13.36, P =. 008), and IDH-wild-type glioblastoma (aHR 21.84, P <. 001) were independent predictors of overall survival. CONCLUSION: Awake surgery preserving the brain connectivity is safe, allows larger resections for insular diffuse gliomas than asleep resection, and positively impacts overall survival.
AB - BACKGROUND: Insular diffuse glioma resection is at risk of vascular injury and of postoperative new neurocognitive deficits. OBJECTIVE: To assess safety and efficacy of surgical management of insular diffuse gliomas. METHODS: Observational, retrospective, single-institution cohort analysis (2005-2019) of 149 adult patients surgically treated for an insular diffuse glioma: transcortical awake resection with intraoperative functional mapping (awake resection subgroup, n = 61), transcortical asleep resection without functional mapping (asleep resection subgroup, n = 50), and stereotactic biopsy (biopsy subgroup, n = 38). All cases were histopathologically assessed according to the 2016 World Health Organization classification and cIMPACT-NOW update 3. RESULTS: Following awake resection, 3/61 patients had permanent motor deficit, seizure control rates improved (89% vs 69% preoperatively, P =. 034), and neurocognitive performance improved from 5% to 24% in tested domains, despite adjuvant oncological treatments. Resection rates were higher in the awake resection subgroup (median 94%) than in the asleep resection subgroup (median 46%; P <. 001). There was more gross total resection (25% vs 12%) and less partial resection (34% vs 80%) in the awake resection subgroup than in the asleep resection subgroup (P <. 001). Karnofsky Performance Status score <70 (adjusted hazard ratio [aHR] 2.74, P =. 031), awake resection (aHR 0.21, P =. 031), isocitrate dehydrogenase (IDH)-mutant grade 2 astrocytoma (aHR 5.17, P =. 003), IDH-mutant grade 3 astrocytoma (aHR 6.11, P <. 001), IDH-mutant grade 4 astrocytoma (aHR 13.36, P =. 008), and IDH-wild-type glioblastoma (aHR 21.84, P <. 001) were independent predictors of overall survival. CONCLUSION: Awake surgery preserving the brain connectivity is safe, allows larger resections for insular diffuse gliomas than asleep resection, and positively impacts overall survival.
KW - Awake surgery
KW - Diffuse glioma
KW - Insula
KW - Overall survival
KW - Resection
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85116550244&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyab254
DO - 10.1093/neuros/nyab254
M3 - Article
C2 - 34383938
AN - SCOPUS:85116550244
SN - 0148-396X
VL - 89
SP - 565
EP - 578
JO - Neurosurgery
JF - Neurosurgery
IS - 4
ER -