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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Functional outcome after pre- versus intraoperative language mapping for glioma resection and evaluation of a classification for language eloquence – a comparative cohort study

Funktionelles Outcome nach prä- versus intraoperativer Sprach-Kartierung zur Resektion von Gliomen und Evaluation einer Klassifikation für Sprach-Eloquenz – eine vergleichende Kohorten-Studie

Meeting Abstract

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  • presenting/speaker Sebastian Ille - Technische Universität München, München, Deutschland
  • Axel Schröder - Technische Universität München, München, Deutschland
  • Lucia Albers - Technische Universität München, München, Deutschland
  • Anna Kelm - Technische Universität München, München, Deutschland
  • Doris Droese - Technische Universität München, München, Deutschland
  • Bernhard Meyer - Technische Universität München, München, Deutschland
  • Sandro Krieg - Technische Universität München, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocV002

doi: 10.3205/20dgnc002, urn:nbn:de:0183-20dgnc0020

Veröffentlicht: 26. Juni 2020

© 2020 Ille et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: A considerable number of gliomas require resection via direct electrical stimulation (DES) during awake craniotomy. Likewise, the feasibility of resecting language-eloquent gliomas purely based on navigated repetitive transcranial magnetic stimulation (nrTMS) has been shown. This study analyzes the outcomes after preoperative nrTMS-based and intraoperative DES-based glioma resection in a substantially large cohort. Likewise, due to the necessity of making location comparable, a classification for language eloquence for gliomas is introduced.

Methods: Between 3/2015 and 5/2019, we prospectively enrolled 100 consecutive cases that were resected based on preoperative nrTMS language mapping (nrTMS group) and 47 cases via intraoperative DES mapping during awake craniotomy (awake group) following a standardized clinical workflow. Outcome measures were determined preoperatively, at 5 days after surgery, and at 3 months after surgery. To make functional eloquence comparable, we developed a classification based on prior publications and our own clinical experience. Groups and classification scores were then correlated with clinical outcomes.

Results: The functional outcome did not differ between groups. However, gross total resection was achieved in more cases of the nrTMS group (87%, vs. 72% in the awake group, p = 0.04). Nonetheless, the awake group showed significantly higher scores of eloquence than the nrTMS group (median 7 points; interquartile range 6-8 vs. 5 points; 3-6.75; p < 0.0001).

Conclusion: Resecting language-eloquent gliomas purely based on nrTMS data is feasible in a high percentage of cases if the described clinical workflow is followed. Moreover, the proposed classification for language eloquence makeslanguage-eloquent tumors comparable, as shown by its correlation with functional and radiological outcomes.