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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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Surgical outcome in diffuse low-grade glioma – contemporary prospective data from the LoG-Glio registry

Chirurgische Ergebnisse bei diffusen niedergradigen Gliomen – aktuelle prospektive Daten des LoG-Glio Registers

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  • presenting/speaker Jan Coburger - Bezirkskrankenhaus Günzburg, Neurochirurgie, Günzburg, Deutschland
  • Stefan Rückriegel - Julius-Maximilians-Universität Würzburg, Neurochirurgie, Würzburg, Deutschland
  • Minou Nadji-Ohl - Klinikum Stuttgart, Neurochirurgie, Stuttgart, Deutschland
  • Christian von der Brelie - Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Constantin Roder - Universitätsklinikum Tübingen, Neurochirurgie, Tübingen, Deutschland
  • Katharina Faust - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland
  • Daniel Sachs - Klinikum Stuttgart, Neurochirurgie, Stuttgart, Deutschland
  • Mario Löhr - Julius-Maximilians-Universität Würzburg, Neurochirurgie, Würzburg, Deutschland
  • Sonja Grüninger - Universität Ulm, Neurochirurgie, Günzburg, Deutschland
  • Peter Vajkoczy - Charité – Universitätsmedizin Berlin, Neurochirurgie, Berlin, Deutschland
  • Marcos Tatagiba - Universitätsklinikum Tübingen, Neurochirurgie, Tübingen, Deutschland
  • Ralf-Ingo Ernestus - Julius-Maximilians-Universität Würzburg, Neurochirurgie, Würzburg, Deutschland
  • Veit Rohde - Georg-August-Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
  • Oliver Ganslandt - Klinikum Stuttgart, Neurochirurgie, Stuttgart, Deutschland
  • Christian Rainer Wirtz - Universität Ulm, Neurochirurgie, Günzburg, Deutschland
  • Andrej Pala - Bezirkskrankenhaus Günzburg, Neurochirurgie, Günzburg, 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. DocV250

doi: 10.3205/20dgnc244, urn:nbn:de:0183-20dgnc2444

Published: June 26, 2020

© 2020 Coburger 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

Text

Objective: Level of evidence for surgical management in low grade glioma (LGG) is low and mainly relies on retrospective series. Hence prospective contemporary assessment of surgical outcome is important to assure surgical quality control and to evaluate surgical strategies.

Methods: Prospective registry data from 2016 to 2019 was searched for diffuse LGG WHO°II and III with complete follow up assessment. Demographic data and the following outcome parameters were assessed at 3 months follow up: new permanent neurological deficits (NPND), NHISS score, ECOG, used surgical technique and presence of residual tumor (RT). Descriptive assessment and multivariate binary regression models for influence of RT and ND were calculated.

Results: 96 patients (pts) were assessed. Median age was 40 yrs (min 18, max 78), 80 pts (90%) had no neurological deficit before surgery; tumors were in eloquent location in 57 pts (60%); median time to surgery was 1 month (min 0, max 27); stereotactic biopsy (STX) was performed in 10 (10%), intended subtotal resection (STR) in 33 (34%) and intended gross total resection (GTR) in 53 pts (55%). 17 pts (18%) had recurrent surgery. The following surgical techniques were used: awake surgery in 19 (20%), intraoperative monitoring/mapping (IOM) in 58 (61%), ultrasound in 29 (31%) and iMRI in 35 pts (37%).

NPND were found in 17 pts (23%). 5 pts (6%) had severe, while 12 (15%) had slight NPND. Highest rate of severe NPND was found in pts, who underwent intended STR (n=3 [11%]) compared to intended GTR with n=2 (5%). No NPNDs were found after STX. In multivariate assessment, none of the surgical techniques but eloquent location influenced presence of NPND. Perioperative complications other than NPND were found in 14 pts (15%). Most common was ischemia (n= 3 [3%]). After surgery, median ECOG remained stable as well as median NHISS. A deterioration was seen in 13 pts (18%) for ECOG, in 19 pts (27%) for NHISS. RT was found in 50 pts (53%) and in 14 pts (26%) with intended GTR. Surgical technique did not influence presence of RT in multi- and bivariate assessment.

Conclusion: Contemporary surgical outcome in diffuse LGG shows a high rate of NPND and a relatively low rate of radiologically complete tumor resection despite intended GTR. Hence, use of intraoperative monitoring/mapping and intraoperative imaging should be considered in any surgery of a diffuse LGG given the mostly eloquent lesions and the crucial importance of a complete tumor resection for these pts survival.