gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Prognosis of malignant glioma as a function of its anatomic location in the brain

Prognose maligner Gliome als Funktion der anatomischen Lokalisation im Großhirn

Meeting Abstract

  • R. Ramnarayan - Department of Neurosurgery, University of Liverpool
  • S. Dodd - Department of Biostatics, University of Liverpool
  • K. Das - Department of Neuroradiology, The Walton Centre for Neurology and Neurosurgery, University of Liverpool
  • V. Heidecke - Neurochirurgische Klinik, Zentralklinikum Augsburg
  • corresponding author N.G. Rainov - Neurochirurgische Klinik, Zentralklinikum Augsburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.07.07

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Ramnarayan et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Models of malignant glioma growth and invasion predict that deep gray matter tumors will need longer to reach a fatal size compared to lobar lesions, mainly because glioma cells in deep gray matter may migrate at a lower rate compared to white matter. It can be argued that maximal surgical resection in such cases would have a survival advantage. The aim of this study was to test the above hypotheses on a cohort of patients with WHO grade 3 and 4 gliomas.

Methods: Patients with WHO grade 3 and 4 gliomas were studied. Clinical parameters included demographics, clinical symptoms at presentation, treatment variables, and overall survival. Radiological features included side, site and size of lesion, peritumoral edema, and mass effect and midline shift. Biostatistics were carried out using log rank tests and univariate and multivariate Cox regression models.

Results: A total of 562 consecutive case records were evaluated, and 121 patients were included in the study. Twenty-three (19.0%) of these were WHO grade 3 and 98 (81%) were WHO grade 4 gliomas. Seventy-two patients (59.5%) were male and 49 (40.5%) female. Tumors had lobar location in 96 cases (79.3%) and deep gray matter location in 25 cases (20.7%). Patients with deep gray matter tumors survived significantly longer than those with lobar lesions (log rank test, p=0.0083). This was true even when accounting for histological diagnosis (WHO grade 3 vs. grade 4). Patients with extensive brain edema survived significantly shorter than those with moderate or no edema (log rank test, p=0.0003). Presence of midline shift (>1 cm) was a statistically significant risk factor for survival (log rank test, p<0.0001). The univariate Cox regression model demonstrated statistical significance for the variables age, side, site (deep vs. lobar) and size of tumor, extensive edema, and mass effect (>1 cm). In the multivariate Cox model tumor grade, site and size on initial scan showed statistical significance.

Conclusions: This study indicates that patients with deep gray matter gliomas may survive significantly longer than those with tumors in a lobar location. This is a novel clinical finding which may confirm the theory of differential invasion of glioma cells. Furthermore, tumor characteristics at initial presentation correlate significantly with length of survival in this cohort of patients.