Surgery of Insular Diffuse Gliomas—Part 1: Transcortical Awake Resection Is Safe and Independently Improves Overall Survival. Issue 4 (12th August 2021)

• Record Type: Journal Article
• Authors: Pallud, Johan; Zanello, Marc; Moiraghi, Alessandro; Peeters, Sophie; Trancart, Bénédicte; Edjlali, Myriam; Oppenheim, Catherine; Varlet, Pascale; Chrétien, Fabrice; Dhermain, Frédéric; Roux, Alexandre; Dezamis, Edouard
• Is Part Of: Neurosurgery. Volume 89:Issue 4(2021)
• Page Start: 565
• Page End: 578
• Publication Date: 2021-08-12
• Subjects: Awake surgery -- Diffuse glioma -- Insula -- Resection -- Survival -- Overall survival; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyab254
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Insular diffuse glioma resection is at risk of vascular injury and of postoperative new neurocognitive deficits. OBJECTIVE: To assess safety and efficacy of surgical management of insular diffuse gliomas. METHODS: Observational, retrospective, single-institution cohort analysis (2005-2019) of 149 adult patients surgically treated for an insular diffuse glioma: transcortical awake resection with intraoperative functional mapping (awake resection subgroup, n = 61), transcortical asleep resection without functional mapping (asleep resection subgroup, n = 50), and stereotactic biopsy (biopsy subgroup, n = 38). All cases were histopathologically assessed according to the 2016 World Health Organization classification and cIMPACT-NOW update 3. RESULTS: Following awake resection, 3/61 patients had permanent motor deficit, seizure control rates improved (89% vs 69% preoperatively, P = .034), and neurocognitive performance improved from 5% to 24% in tested domains, despite adjuvant oncological treatments. Resection rates were higher in the awake resection subgroup (median 94%) than in the asleep resection subgroup (median 46%; P < .001). There was more gross total resection (25% vs 12%) and less partial resection (34% vs 80%) in the awake resection subgroup than in the asleep resection subgroup ( P < .001). Karnofsky Performance Status score <70 (adjusted hazard ratio [aHR] 2.74, P = .031), awake resection (aHR 0.21, P = .031), isocitrate dehydrogenase (IDH)-mutant grade 2 astrocytoma (aHR 5.17, P = .003), IDH-mutant grade 3 astrocytoma (aHR 6.11, P < .001), IDH-mutant grade 4 astrocytoma (aHR 13.36, P = .008), and IDH-wild-type glioblastoma (aHR 21.84, P < .001) were independent predictors of overall survival. CONCLUSION: Awake surgery preserving the brain connectivity is safe, allows larger resections for insular diffuse gliomas than asleep resection, and positively impacts overall survival.