gms | German Medical Science

Objective: Maximized surgical resection has become an important treatment strategy in the modern management of supratentorial lobar low-grade gliomas of the adult. To investigate the difference in prognosis of total versus near total or subtotal resected tumors mostly infiltrating eloquent brain tissue, a retrospective study was undertaken.

Method: Altogether, 66 supratentorial lobar WHO II glioma patients (mean age 35 yrs; from 15-70 yrs, 68% in eloquent location) resected surgically between 2002 and 2014 using functional neuronavigation and intraoperative 1.5 TMR imaging were retrospectively investigated. The primary goal of surgery was to achieve radical resection according to intraoperative T2/FLAIR high-field MR images.

Results: Total resection (TR) was achieved in 36.4% of the patients. Due to infiltration of eloquent brain areas, 19.7% had near total resection (NTR, <8% mean residual tumor volume), 37.9% had subtotal resection (STR, >50% residual tumor) and 6.1% a biopsy. Mean tumor volume was significant smaller in the TR group compared to the STR group (13.6 versus 43,8 ccm). Median progression free survival (PFS) in the TR group was 112 months, in the NTR group 106 months and in the STR group 62 months (mean follow-up time 40.1 months). The overall survival of investigated patients during FU was 100%.

Conclusions: Due to functional neuronavigation and iopMR imaging total or near total tumor resection was possible in 56.1% of patients, with a PFS of at least 106 months. Nearly no difference in PFS between the TR und NTR groups was found, whereas a negative trend to reduced PFS in the STR group was evident. Thus, radical or near radical save resection using neuronavigation and iopMR imaging to spare eloquent brain areas seems to be an optimal surgical strategy.