Article
Extent of resection, functional outcomes and survival for limbic and paralimbic gliomas in a single center experience
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Authors
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Cristina Goga
- Department of Neurosurgery, Geneva University Medical Center, Genf, Schweiz
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Martin Nikolaus Stienen
- Universitätspital Zürich, Klinik für Neurochirurgie, Zürich, Schweiz
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Nicholas Smoll
- University of Newcastle, School of Medicine and Public Health, Newcastle, Australien
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Adrien May
- Department of Neurosurgery, Geneva University Medical Center, Genf, Schweiz
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Shahan Momjian
- Department of Neurosurgery, Geneva University Medical Center, Genf, Schweiz
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Karl Schaller
- Department of Neurosurgery, Geneva University Medical Center, Genf, Schweiz
| Published: | June 18, 2018 |
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Outline
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Objective: The purpose of this report was to describe the authors experience with microsurgical resection of limbic and paralimbic gliomas by retrospectively analyzing surgical results, neurological, functional and survival outcomes.
Methods: Patients who had undergone "maximal safe resections" of WHO Grades I-IV limbic and paralimbic gliomas (mediobasal temporal, cingular, insular and combined frontoorbital - insula- and mediobasal temporal gliomas) at a single institution between 2007 and 2016 were included. Tumor location was differentiated according to the Yasargil classification. Preoperative and post-operative tumor volumes were computed by manual segmentation, using FLAIR and contrast-enhanced T1-weighted MR imaging, and volumetric analysis. Clinical, radiological and outcome parameters were evaluated.
Results: Fifty-six consecutive patients, with a median age of 48.8 years, a median Karnofsky Performance Scale (KPS) score of 90 and a median tumor volume of 38.9 cm3 were followed for 1.8 years (mean). The majority of gliomas involved combinations of the frontoorbital – insula - and mediobasal temporal areas (53%, Yasargil Type 5 lesions), followed by the mediobasal temporal region (25%, Type 1 lesions), the insular region (18%, Type 3 lesions) and the cingulate gyrus (14%, Type 2 lesions). An EOR of > 95% (gross total resection, GTR) was achieved in 41% of the procedures and in 55% the EOR ranged between 50-95% (subtotal resection, STR). WHO grade IV glioma histology was the most common (46%), followed by grade II (36%) and III (11%). A good postoperative KPS (>80) at discharge was recorded in 62% of patients. Permanent disabling motor and language deficits were recorded in 3.6% and 1.8% of patients. Surprisingly good survival rates were recorded among patients with WHO IV histology, with a 1-year and 2-year median OS estimated at 83% and 75% respectively.
Conclusion: Extensive resection is often achievable and is relatively safe even in patients with limbic and paralimbic gliomas of all grades. Surprisingly favorable survival rates after surgery for WHO grade IV gliomas may support microsurgery as the core treatment for malignant limbic and paralimbic gliomas.
