gms | German Medical Science

Objective: High-grade gliomas are diffuse tumors whose prognosis may be poor. Nevertheless there is increasing evidence that total removal can impact on survival significantly. In addition grade III tumors may benefit from adjunctive therapy and outcome may be considerably improved if maximal therapeutical efforts are made.

Methods: We describe a protocol which includes a systematic diagnostic evaluation either with multimodal high magnetic field MRI (3 Tesla with Spectroscopy, Tractography, Perfusion and Diffusion) in order to define anatomical, functional and oncological characteristics of the tumor periphery (T2-weighted area), or with a neuropsychologist in order to evaluate sub-clinical deficits. Aggressive surgical policy includes additional evaluation for patients with tumors in eloquent areas (fMRI for language and motor areas with evaluation of speech by speech therapist and of personality and suitability for awake surgery by neuropsychologist). Intraoperative setting include neurophysiological monitoring for motor areas, awake surgery for language areas and neuronavigator with selected images taken from preoperative study. Postoperatively, all patients underwent MRI (<48 hours) and neuropsychological assessment (within 7 days) including speech evaluation when necessary.

Results: We review a 5-year experience with more than 200 patients operated on at our Department. Analysing for diagnostic assessment we observed that with 3 T MRI a) more multifocal tumors were diagnosed and b) a better indication of tumor extension whose surgical target is T2-weighted infiltrated area. To analyse therapeutic effect we compared this series with a concomitant series operated on without these modern technological aids in our Department. We observed: a) more surgical indications for tumor removal, b) higher rate of total removal (72% vs. 40%), and c) a similar rate of additional neurological deficits at 3-month evaluation (12% vs.11%).

Conclusions: The definition of anatomical and functional characteristics of tumor periphery improves surgical planning, thereby significantly increasing the cure rate (more surgical candidates and higher rate of total tumor removal) and minimizing additional deficits. This purpose is accomplished using state of the art technology and dedicated working team.