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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Comparison of outcome parameters using 60 Hz stimulation vs. monopolar stimulation in patients operated on eloquently located glioblastoma – a retrospective monocentric study

Vergleich der Ergebnisparameter zwischen 60 Hz Stimulation und Monopolar Stimulation bei Patienten mit eloquent lokalisiertem Glioblastom – eine retrospektive monozentrische Studie

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  • presenting/speaker Marian Preetham Suresh - Uniklinik Düsseldorf, Neurochirurgie, Düsseldorf, Deutschland
  • Helena Hibbe - Uniklinik Düsseldorf, Neurochirurgie, Düsseldorf, Deutschland
  • Marion Rapp - Uniklinik Düsseldorf, Neurochirurgie, Düsseldorf, Deutschland
  • Marcel Alexander Kamp - Uniklinik Düsseldorf, Neurochirurgie, Düsseldorf, Deutschland
  • Igor Fischer - Uniklinik Düsseldorf, Neurochirurgie, Düsseldorf, Deutschland
  • Michael Sabel - Uniklinik Düsseldorf, Neurochirurgie, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP051

doi: 10.3205/19dgnc389, urn:nbn:de:0183-19dgnc3894

Published: May 8, 2019

© 2019 Suresh et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To compare the post-operative outcome (NIHSS, Karnofsky), extent of resection, the progression free survival (PFS) and overall survival (OAS) of patients diagnosed with primary diagnosed Glioblastoma from 2007 to 2016 operated using 60 Hz stimulation vs Monopolar stimulation.

Methods: The retrospective study includes a total of 126 patients. 58 operated awake with 60 Hz cortical bipolar stimulation, and 68 operated using monopolar stimulation and additional SSEP and MEP monitoring (30 of them awake with additional 60 Hz Stim, 38 under general anaesthesia). All patients were treated with the Stupp protocol after surgery. Pre and post-operative magnetic resonance imaging (MRI), the National Institute of Health (NIH) score and Karnofsky index were assed pre and post operatively. Tumor volumetric analyses were done using a commercial software. PFS and OAS were calculated respectively. Wilcoxon and t-tests were used for univariate analysis and linear regression for multivariate analysis. OAS and PFS were transformed by applying natural logarithm, in order to achieve a distribution closer to normal.

Results: No significant difference in post-operative extent of resection was found between 60 Hz stimulation only with those performed using monopolar or combined stimulation (T-test, p=0.57). Patients operated using monopolar stimulation and SSEP and MEP had, on average, a 3 point better post-operative NIH score (linear regression (LR), p<.001) and 19 points better Karnofsky index (LR, p<10–9). The 3 Month follow up NIHSS and Karnofsky was also better for those operated using monopolar stimulation and SSEP and MEP monitoring (NIHSS-P<0.0043), (Karnofsky P<0.001). There was a difference of 3 Months of PFS and a weak trend of higher OAS (statistically not significant) for patients operated awake with 60 Hz stimulation

Conclusion: In comparing both methods we found a significant improved functional outcome for patients operated with monopolar stimulation and SSEP and MEP monitoring.