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Meta-Analysis
. 2019 Jan;161(1):99-107.
doi: 10.1007/s00701-018-3732-4. Epub 2018 Nov 21.

Impact of intraoperative stimulation mapping on high-grade glioma surgery outcome: a meta-analysis

Jasper Kees Wim Gerritsen  1 , Lidia Arends  2 , Markus Klimek  3 , Clemens Maria Franciscus Dirven  4 , Arnaud Jean-Pierre Edouard Vincent  4
Affiliations
Meta-Analysis

Impact of intraoperative stimulation mapping on high-grade glioma surgery outcome: a meta-analysis

Jasper Kees Wim Gerritsen et al. Acta Neurochir (Wien). 2019 Jan.

Abstract

Background: Intraoperative stimulation mapping (ISM) using electrocortical mapping (awake craniotomy, AC) or evoked potentials has become a solid option for the resection of supratentorial low-grade gliomas in eloquent areas, but not as much for high-grade gliomas. This meta-analysis aims to determine whether the surgeon, when using ISM and AC, is able to achieve improved overall survival and decreased neurological morbidity in patients with high-grade glioma as compared to resection under general anesthesia (GA).

Methods: A systematic search was performed to identify relevant studies. Adult patients were included who had undergone craniotomy for high-grade glioma (WHO grade III or IV) using ISM (among which AC) or GA. Primary outcomes were rate of postoperative complications, overall postoperative survival, and percentage of gross total resections (GTR). Secondary outcomes were extent of resection and percentage of eloquent areas.

Results: Review of 2049 articles led to the inclusion of 53 studies in the analysis, including 9102 patients. The overall postoperative median survival in the AC group was significantly longer (16.87 versus 12.04 months; p < 0.001) and the postoperative complication rate was significantly lower (0.13 versus 0.21; p < 0.001). Mean percentage of GTR was significantly higher in the ISM group (79.1% versus 47.7%, p < 0.0001). Extent of resection and preoperative patient KPS were indicated as prognostic factors, whereas patient KPS and involvement of eloquent areas were identified as predictive factors.

Conclusions: These findings suggest that surgeons using ISM and AC during their resections of high-grade glioma in eloquent areas experienced better surgical outcomes: a significantly longer overall postoperative survival, a lower rate of postoperative complications, and a higher percentage of GTR.

Keywords: Awake craniotomy; Extent of resection; Glioblastoma; Morbidity; Mortality.

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Conflict of interest statement

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. I confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Ethical approval

For this type of study, formal consent is not required.

This article does not contain any studies with human participants performed by any of the authors.

No portions of the contents of this paper have been presented nor published previously.

Figures

Fig. 1
Fig. 1
Flowchart of total records identified through database searching
Fig. 2
Fig. 2
Forest plot
Fig. 3
Fig. 3
Extent of resection and overall survival
Fig. 4
Fig. 4
Extent of resection and postoperative complication rate
See this image and copyright information in PMC

Comment in

References

    1. Black PM, Ronnen SF. Cortical mapping for defining the limits of tumor resection. Neurosurgery. 1987;20:914–919. doi: 10.1227/00006123-198706000-00016. - DOI - PubMed
    1. Brown TJ, Brandmeir NJ, Church EW, Brennan MC, Li M, Rakszawski KL, et al. Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol. 2016;2:1460–1469. doi: 10.1001/jamaoncol.2016.1373. - DOI - PMC - PubMed
    1. Chaichana K, Olivi A, Parker S, Quiñones-Hinojosa A. A proposed classification system that projects outcomes based on preoperative variables for adult patients with glioblastoma multiforme. J Neurosurg. 2010;112:997–1004. doi: 10.3171/2009.9.JNS09805. - DOI - PubMed
    1. Chang EF, Barbaro NM, Berger MS, Chang SM, Clark A, McDermott MW, et al. Functional mapping-guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long-term survival. Clinical article. J Neurosurg. 2011;114:566–573. doi: 10.3171/2010.6.JNS091246. - DOI - PMC - PubMed
    1. Danks RA, Aglio LS, Gugino LD, Black PM. Craniotomy under local anesthesia and monitored conscious sedation for the resection of tumors involving eloquent cortex. J Neuro-Oncol. 2000;49:131–139. doi: 10.1023/A:1026577518902. - DOI - PubMed

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