Jun Muto1, Edouard Dezamis2, Odile Rigaux-Viode3, Sophie Peeters4, Alexandre Roux2, Marc Zanello3, Charles Mellerio5, Xavier Sauvageon6, Pascale Varlet7, Catherine Oppenheim5, Johan Pallud8. 1. Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Neurosurgery, Keio University School of Medicine, Minato, Tokyo, Japan. 2. Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France. 3. Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France. 4. Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; University of Texas Southwestern Medical Center, Dallas, Texas, USA. 5. Paris Descartes University, Sorbonne Paris Cité, Paris, France; IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France; Department of Neuroradiology, Sainte-Anne Hospital, Paris, France. 6. Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Neuro-Anaesthesia and Neuro-Intensive Care, Sainte-Anne Hospital, Paris, France. 7. Paris Descartes University, Sorbonne Paris Cité, Paris, France; IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France; Department of Neuropathology, Sainte-Anne Hospital, Paris, France. 8. Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France. Electronic address: johanpallud@hotmail.com.
Abstract
OBJECTIVE: We assessed the impact of surgery on postoperative cognitive function and ability to work in adult patients with a diffuse low-grade glioma involving eloquent brain regions and having a functional-based maximal surgical resection using intraoperative corticosubcortical mapping under awake conditions. METHODS: We prospectively included 39 consecutive patients with diffuse isocitrate dehydrogenase-mutant low-grade glioma without preoperative and adjuvant oncologic treatment and assessed preoperative (mean, 24.1 ± 21.2 days before surgery) and postoperative (mean, 14.6 ± 13.2 months after surgery) cognitive evaluations and ability to work together with clinical, imaging, therapeutic, and follow-up characteristics before tumor progression. RESULTS: None of the 3 patients without preoperative cognitive deficit had postoperative worsening. We observed a significant inverse interaction between worsened postoperative cognitive function and extent of resection: 80.0%, 18.8%, and 16.7% of worsening after partial, subtotal, and total resection, respectively (P = 0.020). We observed an independent interaction between improved postoperative cognitive function and extent of resection: 20.0%, 43.7%, and 44.4% of improvement after partial, subtotal, and total resection, respectively (P = 0.022). Of the employed patients, 61.8% were unable to work preoperatively and 82.4% resumed their employment postoperatively (mean, 6.9 ± 5.5 months). We observed an independent interaction between postoperative ability to work, similar or superior to preoperative work capacity and extent of resection (P < 0.001): 20.0%, 87.5%, and 100% ability to work after partial, subtotal resection, and total resection. CONCLUSIONS: The extent of the functional-based surgical resection and the residual tumor for diffuse low-grade gliomas involving eloquent brain regions correlate with postoperative cognitive outcomes and return to work rates.
OBJECTIVE: We assessed the impact of surgery on postoperative cognitive function and ability to work in adult patients with a diffuse low-grade glioma involving eloquent brain regions and having a functional-based maximal surgical resection using intraoperative corticosubcortical mapping under awake conditions. METHODS: We prospectively included 39 consecutive patients with diffuse isocitrate dehydrogenase-mutant low-grade glioma without preoperative and adjuvant oncologic treatment and assessed preoperative (mean, 24.1 ± 21.2 days before surgery) and postoperative (mean, 14.6 ± 13.2 months after surgery) cognitive evaluations and ability to work together with clinical, imaging, therapeutic, and follow-up characteristics before tumor progression. RESULTS: None of the 3 patients without preoperative cognitive deficit had postoperative worsening. We observed a significant inverse interaction between worsened postoperative cognitive function and extent of resection: 80.0%, 18.8%, and 16.7% of worsening after partial, subtotal, and total resection, respectively (P = 0.020). We observed an independent interaction between improved postoperative cognitive function and extent of resection: 20.0%, 43.7%, and 44.4% of improvement after partial, subtotal, and total resection, respectively (P = 0.022). Of the employed patients, 61.8% were unable to work preoperatively and 82.4% resumed their employment postoperatively (mean, 6.9 ± 5.5 months). We observed an independent interaction between postoperative ability to work, similar or superior to preoperative work capacity and extent of resection (P < 0.001): 20.0%, 87.5%, and 100% ability to work after partial, subtotal resection, and total resection. CONCLUSIONS: The extent of the functional-based surgical resection and the residual tumor for diffuse low-grade gliomas involving eloquent brain regions correlate with postoperative cognitive outcomes and return to work rates.
Authors: Lucas Alverne F Albuquerque; João Paulo Almeida; Leonardo José Monteiro de Macêdo Filho; Andrei F Joaquim; Hugues Duffau Journal: Neurosurg Rev Date: 2020-08-07 Impact factor: 3.042
Authors: Philip C De Witt Hamer; Philip C De Witt Hamer; Martin Klein; Shawn L Hervey-Jumper; Jeffrey S Wefel; Mitchel S Berger Journal: Neurosurgery Date: 2021-03-15 Impact factor: 4.654