Surgery of Insular Diffuse Gliomas-Part 1: Transcortical Awake Resection Is Safe and Independently Improves Overall Survival.

Adult Brain Neoplasms / surgery Glioma / surgery Humans Retrospective Studies Treatment Outcome Wakefulness
Awake surgery Diffuse glioma Insula Overall survival Resection Survival

Journal

Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914

Informations de publication

Date de publication:
15 09 2021
Historique:
received: 05 11 2020
accepted: 16 05 2021
pubmed: 13 8 2021
medline: 26 11 2021
entrez: 12 8 2021
Statut: ppublish

Résumé

Insular diffuse glioma resection is at risk of vascular injury and of postoperative new neurocognitive deficits. To assess safety and efficacy of surgical management of insular diffuse gliomas. 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. 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. Awake surgery preserving the brain connectivity is safe, allows larger resections for insular diffuse gliomas than asleep resection, and positively impacts overall survival.

Sections du résumé

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.

Identifiants

DOI: 10.1093/neuros/nyab254 PMID: 34383938
pubmed: 34383938
pii: 6349320
doi: 10.1093/neuros/nyab254
doi:

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

565-578

Informations de copyright

© Congress of Neurological Surgeons 2021.

Auteurs

Johan Pallud (J)

Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.
ORCID: 0000-0002-1652-9844

Marc Zanello (M)

Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.

Alessandro Moiraghi (A)

Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.

Sophie Peeters (S)

Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA.

Bénédicte Trancart (B)

Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.

Myriam Edjlali (M)

Université de Paris, Sorbonne Paris Cité, Paris, France.
Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.

Catherine Oppenheim (C)

Université de Paris, Sorbonne Paris Cité, Paris, France.
Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.

Pascale Varlet (P)

Université de Paris, Sorbonne Paris Cité, Paris, France.
Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.
Department of Neuropathology, GHU Paris-Sainte-Anne Hospital, Paris, France.

Fabrice Chrétien (F)

Université de Paris, Sorbonne Paris Cité, Paris, France.
Department of Neuropathology, GHU Paris-Sainte-Anne Hospital, Paris, France.

Frédéric Dhermain (F)

Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France.

Alexandre Roux (A)

Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.
Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.

Edouard Dezamis (E)

Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, Paris, France.
Université de Paris, Sorbonne Paris Cité, Paris, France.
Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Surgery of Insular Diffuse Gliomas-Part 1:...
questionsmedicales.fr › Maladies du système nerveux › Tumeurs du système nerveux › Tumeurs du système nerveux central › Tumeurs du cerveau › Surgery of Insular Diffuse Gliomas-Part 1:...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs du tissu nerveux › Tumeurs neuroectodermiques › Tumeurs neuroépitheliales › Gliome › Surgery of Insular Diffuse Gliomas-Part 1:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Surgery of Insular Diffuse Gliomas-Part 1:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Surgery of Insular Diffuse Gliomas-Part 1:...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Surgery of Insular Diffuse Gliomas-Part 1:...
questionsmedicales.fr › Phénomènes physiologiques de l'appareil locomoteur et du système nerveux › Phénomènes physiologiques du système nerveux › Éveil › Vigilance › Surgery of Insular Diffuse Gliomas-Part 1:...