Multimodal integrated approaches in low grade glioma surgery

Surgical management of Diffuse Low-Grade Gliomas (DLGGs) has radically changed in the last 20 years. Awake surgery (AS) in combination with Direct Electrical Stimulation (DES) and real-time neuropsychological testing (RTNT) permits continuous intraoperative feedback, thus allowing to increase the ex...

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Bibliographic Details
Published in:Scientific reports 2021-05, Vol.11 (1), p.9964-9964, Article 9964
Main Authors: Ius, Tamara, Mazzucchi, Edoardo, Tomasino, Barbara, Pauletto, Giada, Sabatino, Giovanni, Della Pepa, Giuseppe Maria, La Rocca, Giuseppe, Battistella, Claudio, Olivi, Alessandro, Skrap, Miran
Format: Article
Language:English
Subjects:
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Brain cancer
Electrical stimuli
Ethics
Functional magnetic resonance imaging
Glioma
Humanities and Social Sciences
Informed consent
Magnetic resonance imaging
Measuring techniques
multidisciplinary
Neuropsychology
Neurosciences
Neurosurgery
Psychology
Science
Science (multidisciplinary)
Software
Surgery
Tumors
Variables
Volumetric analysis
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Summary:Surgical management of Diffuse Low-Grade Gliomas (DLGGs) has radically changed in the last 20 years. Awake surgery (AS) in combination with Direct Electrical Stimulation (DES) and real-time neuropsychological testing (RTNT) permits continuous intraoperative feedback, thus allowing to increase the extent of resection (EOR). The aim of this study was to evaluate the impact of the technological advancements and integration of multidisciplinary techniques on EOR. Two hundred and eighty-eight patients affected by DLGG were enrolled. Cases were stratified according to the surgical protocol that changed over time: 1. DES; 2. DES plus functional MRI/DTI images fused on a NeuroNavigation system; 3. Protocol 2 plus RTNT. Patients belonging to Protocol 1 had a median EOR of 83% (28–100), while those belonging to Protocol 2 and 3 had a median EOR of 88% (34–100) and 98% (50–100) respectively ( p  = 0.0001). New transient deficits with Protocol 1, 2 and 3 were noted in 38.96%, 34.31% and 31,08% of cases, and permanent deficits in 6.49%, 3.65% and 2.7% respectively. The average follow-up period was 6.8 years. OS was influenced by molecular class ( p  = 0.028), EOR ( p  = 0.018) and preoperative tumor growing pattern ( p  = 0.004). Multimodal surgical approach can provide a safer and wider removal of DLGG with potential subsequent benefits on OS. Further studies are necessary to corroborate our findings.
ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-021-87924-2