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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Assessment of functional outcome after resection of eloquently located lower grade gliomas based on the LoG-Glio registry

Charakterisieren des funktionellen Outcomes nach der chirurgischen Resektion der eloquente lokalisierten lower grade gliomas basierend auf Log-Glio Registerdaten

Meeting Abstract

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  • presenting/speaker Andrej Pala - Universitätsklinik Ulm am Standort Günzburg, Klinik für Neurochirurgie, Günzburg, Deutschland
  • Julia Sophie Onken - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Stefan Rückriegel - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Christian von der Brelie - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
  • Minou Nadji-Ohl - Klinikum Stuttgart, Katharinenhospital, Neurochirurgische Klinik, Stuttgart, Deutschland
  • Marie-Thérèse Forster - Universitätsklinikum Frankfurt, Frankfurt a. M., Deutschland
  • Rüdiger Gerlach - Helios Klinikum Erfurt, Klinik für Neurochirurgie, Erfurt, Deutschland
  • Meike Unteroberdörster - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Constantin Roder - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • K. Kniese - KRH Klinikum Region Hannover, Neurochirurgie, Hannover, Deutschland
  • Stefan Schommer - Klinikum Stuttgart, Katharinenhospital, Neurochirurgische Klinik, Stuttgart, Deutschland
  • Dietrich Rothenbacher - Universitätsklinikum Ulm, Epidemiologie, Ulm, Deutschland
  • Gabriele Nagel - Universitätsklinikum Ulm, Epidemiologie, Ulm, Deutschland
  • Christian Rainer Wirtz - Universitätsklinik Ulm am Standort Günzburg, Klinik für Neurochirurgie, Günzburg, Deutschland
  • Ralf-Ingo Ernestus - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Arya Nabavi - KRH Klinikum Region Hannover, Neurochirurgie, Hannover, Deutschland
  • Marcos Tatagiba - Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
  • Marcus Czabanka - Universitätsklinikum Frankfurt, Frankfurt a. M., Deutschland
  • Oliver Ganslandt - Klinikum Stuttgart, Katharinenhospital, Neurochirurgische Klinik, Stuttgart, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
  • Mario Löhr - Universitätsklinikum Würzburg, Neurochirurgische Klinik und Poliklinik, Würzburg, Deutschland
  • Peter Vajkoczy - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • presenting/speaker Jan Coburger - Universitätsklinik Ulm am Standort Günzburg, Klinik für Neurochirurgie, Günzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV136

doi: 10.3205/22dgnc136, urn:nbn:de:0183-22dgnc1360

Veröffentlicht: 25. Mai 2022

© 2022 Pala 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: Lower grade gliomas (LGG) often infiltrate eloquent regions, so that neurological impairment and oncological benefit by surgery have to be balanced. Aim of our study was to assess rate of permanent deficits and its risk factors in eloquently located LGGs.

Methods: We retrieved all patients harboring an eloquently located astrocytoma or oligodendroglioma WHO grade II or III from the prospective LoG-Glio Database. Patients without surgery or incomplete postoperative data were excluded. Finally, 83 patients met the inclusion criteria. Exploratory statistical assessment was performed. Correlations were calculated by Spearman`s rho. We used Sign rank test to evaluate differences in connected samples. Furthermore, multivariate regression analysis model for new permanent neurological deficits was calculated.

Results: Diffuse astrocytoma was found in 62% and 71% were identified as WHO grade II. Eloquent regions were predominantly motor (45%) and language (40%) cortex and fiber pathways. Awake surgery was done in 23% of cases, and intraoperative monitoring (IOM) was used in 80% of cases. Complete tumor removal (CTR) was intended in 51% and, based on radiological criteria, was achieved in 62% of those patients. At first follow up, National Institutes of Health Stroke Score (NIHSS) was significantly decreased in 27 patients compared to preoperative NIHSS values (33%, p<0.001). Further, comparing preoperative and follow up NHISS scores, an improvement was seen only in 5/71 patients (7%), while 27 patients remained stable (56%). Comparing postoperative and follow up NIHSS, no statistical difference was found (p=0.213). CTR (p=0.014, OR 18.5), and Eastern Cooperative Oncology Group performance status > 0 (p=0.045, OR 5.7) were independent predictors for permanent postoperative deficit according to multivariable regression model.

Conclusion: Patients with eloquently located LGGs suffering from preoperative deficits are at risk to experience a further deterioration after surgery. Radical tumor resection in eloquent regions is associated with a high risk of permanent deficits which should be well consented with each patient and balanced with respective oncological benefit. Despite postoperative neurological improvement, only a minority of those patients presenting neurological deterioration after surgery recovered to their preoperative NIHSS.