Functional and oncological outcomes following awake surgical resection using intraoperative cortico-subcortical functional mapping for supratentorial gliomas located in eloquent areas

Abstract

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.

Material and 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.

Keywords: Awake craniotomy; Employment; Extent of resection; Functional status; Glioma; Outcomes; Surgery.