Functional-Based Resection Does Not Worsen Quality of Life in Patients with a Diffuse Low-Grade Glioma Involving Eloquent Brain Regions: A Prospective Cohort Study

Jun Muto; Edouard Dezamis; Odile Rigaux-Viode; Sophie Peeters; Alexandre Roux; Marc Zanello; Charles Mellerio; Xavier Sauvageon; Pascale Varlet; Catherine Oppenheim; Johan Pallud

doi:10.1016/j.wneu.2018.01.213

Functional-Based Resection Does Not Worsen Quality of Life in Patients with a Diffuse Low-Grade Glioma Involving Eloquent Brain Regions: A Prospective Cohort Study

World Neurosurg. 2018 May:113:e200-e212. doi: 10.1016/j.wneu.2018.01.213. Epub 2018 Feb 9.

Authors

Affiliations

¹ Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Neurosurgery, Keio University School of Medicine, Minato, Tokyo, Japan.
² Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France.
³ Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
⁴ Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁵ Paris Descartes University, Sorbonne Paris Cité, Paris, France; IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France; Department of Neuroradiology, Sainte-Anne Hospital, Paris, France.
⁶ Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Neuro-Anaesthesia and Neuro-Intensive Care, Sainte-Anne Hospital, Paris, France.
⁷ Paris Descartes University, Sorbonne Paris Cité, Paris, France; IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France; Department of Neuropathology, Sainte-Anne Hospital, Paris, France.
⁸ Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; IMA-BRAIN, Inserm, U894, Centre de Psychiatrie et Neurosciences, Paris, France. Electronic address: johanpallud@hotmail.com.

PMID: 29432943
DOI: 10.1016/j.wneu.2018.01.213

Abstract

Objective: We assessed the impact of surgery on postoperative cognitive function and ability to work in adult patients with a diffuse low-grade glioma involving eloquent brain regions and having a functional-based maximal surgical resection using intraoperative corticosubcortical mapping under awake conditions.

Methods: We prospectively included 39 consecutive patients with diffuse isocitrate dehydrogenase-mutant low-grade glioma without preoperative and adjuvant oncologic treatment and assessed preoperative (mean, 24.1 ± 21.2 days before surgery) and postoperative (mean, 14.6 ± 13.2 months after surgery) cognitive evaluations and ability to work together with clinical, imaging, therapeutic, and follow-up characteristics before tumor progression.

Results: None of the 3 patients without preoperative cognitive deficit had postoperative worsening. We observed a significant inverse interaction between worsened postoperative cognitive function and extent of resection: 80.0%, 18.8%, and 16.7% of worsening after partial, subtotal, and total resection, respectively (P = 0.020). We observed an independent interaction between improved postoperative cognitive function and extent of resection: 20.0%, 43.7%, and 44.4% of improvement after partial, subtotal, and total resection, respectively (P = 0.022). Of the employed patients, 61.8% were unable to work preoperatively and 82.4% resumed their employment postoperatively (mean, 6.9 ± 5.5 months). We observed an independent interaction between postoperative ability to work, similar or superior to preoperative work capacity and extent of resection (P < 0.001): 20.0%, 87.5%, and 100% ability to work after partial, subtotal resection, and total resection.

Conclusions: The extent of the functional-based surgical resection and the residual tumor for diffuse low-grade gliomas involving eloquent brain regions correlate with postoperative cognitive outcomes and return to work rates.

Keywords: Ability to work; Cognitive functioning; Diffuse low-grade glioma; Intraoperative functional mapping; Surgery.

MeSH terms

Adult
Brain Mapping
Brain Neoplasms / complications
Brain Neoplasms / genetics
Brain Neoplasms / pathology
Brain Neoplasms / surgery*
Female
Glioma / complications
Glioma / genetics
Glioma / pathology
Glioma / surgery*
Humans
Language Disorders / etiology
Magnetic Resonance Imaging
Male
Middle Aged
Neurocognitive Disorders / etiology
Neurocognitive Disorders / prevention & control*
Neurosurgical Procedures / methods*
Postoperative Complications / etiology
Postoperative Complications / prevention & control*
Prospective Studies
Quality of Life*
Recovery of Function
Seizures / etiology
Unemployment
Work Capacity Evaluation
Young Adult