Article
Surgery for low-grade glioma infiltrating the central cerebral region: location as a predictive factor for neurological deficit, epileptological outcome and quality of life
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Authors
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Philippe Schucht
- Universitätsklinik für Neurochirurgie, Inselspital, Bern, Schweiz
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Fadi Ghareeb
- Department of Neurosurgery, Riyadh Military Hospital, Riyadh, Saudi Arabia
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Hugues Duffau
- Département de Neurochirurgie, Hôpital Gui de Chauliac, Montpellier, France
| Published: | May 21, 2013 |
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Outline
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Objective: A main concern in low-grade glioma (WHO Grade II) surgery is to maintain patients’ functional integrity. This is particularly relevant for gliomas in the central region, where damage to surrounding tissue can have grave repercussions. The objective of this investigation is to determine morbidity and seizure outcome after surgery for central low-grade glioma, and to assess whether patients returned to their previous work.
Method: We compared 33 consecutive patients with low-grade glioma in the central region (central cohort) with 31 consecutive patients with low-grade glioma of the frontal lobe (control cohort), all operated upon between February 2007 and April 2010 at a single institution.
Results: All patients had medically intractable seizures before surgery. Median extent of resection was 92% (range 80-97%) in the central cohort and 93% (range 83–98%) in the control cohort (p=1.0). Seizure freedom (Engel I) was achieved in 26 out of 31 (83.9%) patients in the control cohort, but only in 4 out of 33 (12.1%) patients in the central cohort (p<0.0001). The return-to-work rate was low at only 12.1% (4/33) in the central cohort compared to 90.3% (28/31) in the control cohort (p<0.0001).
Conclusions: Resection of central low-grade glioma is feasible and safe using appropriate intra-operative mapping methods. However, seizure control remains poor in these patients, which contrasts markedly with both our frontal control cohort and the literature. Poor seizure control ultimately determines quality of life in patients with central region gliomas, as the vast majority will not be able to return to work.
