Resection of high-grade glioma involving language areas assisted by multimodal techniques under general anesthesia: a retrospective study

Chinese Neurosurgical Journal

Research

Meng Cui¹  Bing Guan²  Yukun Liu³  Xin Gao⁴  Hewen Chen⁴  Jiayu Liu⁴  Qingbao Guo⁴  Xiaodong Ma⁴  Chunhui Zhou⁵ 

[1] Department of Emergency, the Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China;Department of Neurosurgery, the First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China;Department of Health Economics, the First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China;Department of Neurosurgery, Chinese Air Force Medical Center, Beijing, China;Department of Neurosurgery, the First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China;Department of Neurosurgery, the Sixth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China;

关键词: High-grade glioma;    Language;    Multimodal techniques;    Intraoperative MRI;    General anesthesia;   

DOI  :  10.1186/s41016-023-00340-5

 received in 2023-04-23, accepted in 2023-08-21,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMultimodal techniques-assisted resection of glioma under general anesthesia (GA) has been shown to achieve similar clinical outcomes as awake craniotomy (AC) in some studies. In this study, we aim to validate the use of multimodal techniques can achieve the maximal safe resection of high-grade glioma involving language areas (HGILAs) under GA.MethodsHGILAs cases were reviewed and collected between January 2009 and December 2020 in our center. Patients were separated into multimodal group (using neuronavigation, intraoperative MRI combined with direct electrical stimulation [DES] and neuromonitoring [IONM]) and conventional group (neuronavigation alone) and clinical outcomes were compared between groups. Studies of HGILAs were reviewed systematically and the meta-analysis results of previous (GA or AC) studies were compared with our results.ResultsFinally, there were 263 patients in multimodal group and 137 patients in conventional group. Compared to the conventional group, the multimodal group achieved the higher median EOR (100% versus 94.32%, P < 0.001) and rate of gross total resection (GTR) (73.8% versus 36.5%, P < 0.001) and the lower incidence of permanent language deficit (PLD) (9.5% versus 19.7%, P = 0.004). The multimodal group achieved the longer median PFS (16.8 versus 10.3 months, P < 0.001) and OS (23.7 versus 15.7 months, P < 0.001) than the conventional group. The multimodal group achieved a higher rate of GTR than the cohorts in previous multimodal studies under GA and AC (73.8% versus 55.7% [95%CI 32.0–79.3%] versus 53.4% [35.5–71.2%]). The multimodal group had a lower incidence of PLD than the cohorts in previous multimodal studies under GA (9.5% versus 14.0% [5.8–22.1%]) and our incidence of PLD was a little higher than that of previous multimodal studies under AC (9.5% versus 7.5% [3.7–11.2%]). Our multimodal group also achieved a relative longer survival than previous studies.ConclusionsSurgery assisted by multimodal techniques can achieve maximal safe resection for HGILAs under GA. Further prospective studies are needed to compare GA with AC for HGILAs.

【 授权许可】

CC BY   
© Department of Neurosurgery Beijing Tiantan Hospital 2023

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