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Surgical treatment of high-grade gliomas in motor areas. The impact of different supportive technologies: a 171-patient series

  • Clinical Study – Patient Study
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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.

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Authors and Affiliations

  1. Section of Neurosurgery, Department of Neurological Sciences and Vision, University Hospital, Verona, Italy

    Andrea Talacchi, Francesco Sala, Mario Ganau, Vincenzo Tramontano, Barbara Santini & Massimo Gerosa

  2. Division of Neurosurgery, University Hospital, Verona, Italy

    Sergio Turazzi & Roberta Gambin

  3. Section of Epidemiology and Medical Statistics, Department of Hygiene and Public Health, University of Verona, Verona, Italy

    Francesca Locatelli

  4. Section of Neurology, Department of Neurological Sciences and Vision, University Hospital, Verona, Italy

    Paolo Manganotti

  5. Division of Neuroradiology, University Hospital, Verona, Italy

    Alberto Beltramello & Franco Alessandrini

  6. Division of Neurology, “Sacro Cuore” Hospital, Negrar, Verona, Italy

    Paola Lanteri

  7. Section of Neurosurgery, Department of Neurological Sciences and Vision, University Hospital, P. Stefani 1, 37126, Verona, Italy

    Andrea Talacchi

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  1. Andrea Talacchi
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  2. Sergio Turazzi
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  3. Francesca Locatelli
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  4. Francesco Sala
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Correspondence to Andrea Talacchi.

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Talacchi, A., Turazzi, S., Locatelli, F. et al. Surgical treatment of high-grade gliomas in motor areas. The impact of different supportive technologies: a 171-patient series. J Neurooncol 100, 417–426 (2010). https://doi.org/10.1007/s11060-010-0193-x

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  • DOI: https://doi.org/10.1007/s11060-010-0193-x

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