Details

Autor(en) / Beteiligte

• Li, Ying-Ching
• Chiu, Hsiao-Yean
• Lin, Ya-Jui
• Chen, Ko-Ting
• Hsu, Peng-Wei
• Huang, Yin-Cheng
• Chen, Pin-Yuan
• Wei, Kuo-Chen

Titel

The Merits of Awake Craniotomy for Glioblastoma in the Left Hemispheric Eloquent Area: One Institution Experience

Ist Teil von

• Clinical neurology and neurosurgery, 2021-01, Vol.200, p.106343-106343, Article 106343

Ort / Verlag

Netherlands: Elsevier B.V

Erscheinungsjahr

2021

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• •Many studies have reported the benefits of how AC can improve the survival of patients with glioma. However, most of these studies have focused on low-grade glioma, and few studies have reported patients with high-grade glioma or glioblastoma, and some studies have included a mix of tumor pathologies.•This represents the largest comparative study of AC and surgery under GA for treatment focused on glioblastoma located in left hemispheric eloquent areas in the literature. Awake craniotomy (AC) with intraoperative stimulation mapping is the standard treatment for gliomas, especially those on the eloquent cortex. Many studies have reported survival benefits with the use of AC in patients with glioma, however most of these studies have focused on low-grade glioma. The aim of this study was to evaluate the experience of one treatment center over 10 years for resection of left hemispheric eloquent glioblastoma. This retrospective analysis included 48 patients with left hemispheric eloquent glioblastoma who underwent AC and 61 patients who underwent surgery under general anesthesia (GA) between 2008 and 2018. Perioperative risk factors, extent of resection (EOR), preoperative and postoperative Karnofsky Performance Score (KPS), progression-free survival (PFS) and overall survival (OS) were assessed. The postoperative KPS was significantly lower in the GA patients compared to the AC patients (p = 0.002). The EOR in the GA group was 90.2% compared to 94.9% in the AC group (p = 0.003). The mean PFS was 18.9 months in the GA group and 23.2 months in the AC group (p = 0.001). The mean OS was 25.5 months in all patients, 23.4 months in the GA group, and 28.1 months in the AC group (p < 0.001). In multivariate analysis, the EOR and preoperative KPS independently predicted better OS. The patients with left hemispheric eloquent glioblastoma in this study had better neurological outcomes, maximal tumor removal, and better PFS and OS after AC than surgery under GA. Awake craniotomy should be performed in these patients if the resources are available.