Eloquent lower grade gliomas, a highly vulnerable cohort: assessment of patients’ functional outcome after surgery based on the LoG-glio registry
Creators: name: Coburger, Jan
name: Onken, Julia
name: Rueckriegel, Stefan
name: Von Der Brelie, Christian
name: Nadji-Ohl, Minou
name: Forster, Marie-Therese
name: Gerlach, Rüdiger
name: Unteroberdörster, Meike
name: Roder, Constantin
name: Kniese, Katja
name: Schommer, Stefan
name: Rothenbacher, Dietrich
name: Nagel, Gabriele
name: Wirtz, Christian Rainer
name: Ernestus, Ralf-Ingo
name: Nabavi, Arya
name: Tatagiba, Marcos
name: Czabanka, Marcus
name: Ganslandt, Oliver
name: Rohde, Veit
name: Löhr, Mario
name: Vajkoczy, Peter
name: Pala, Andrej
Publisher: name: Universität Ulm
Year: 2022
Subjects: subject: LGG
subject: neurological deficit
subject: awake surgery
subject: iMRI = intraoperative MRI
subject: iUS = intraoperative ultrasound
subject: intraoperative monitoring (IOM)
subject: eloquent area tumours
subject: eloquent area surgery
subject: DDC 610 / Medicine &amp; health
subject: Glioma
subject: Magnetic resonance imaging; Methods
subject: Neurosurgical procedures
subject: Radiology, Interventional
subject: Wakefulness
subject: Gliom
subject: Kernspintomografie
subject: Interventionsradiologie

description: Majority of lower grade glioma (LGG) are located eloquently rendering surgical resection challenging. Aim of our study was to assess rate of permanent deficits and its predisposing risk factors. We retrieved 83 patients harboring an eloquently located LGGs from the prospective LoG-Glio Database. Patients without surgery or incomplete postoperative data were excluded. Sign rank test, explorative correlations by Spearman ρ and multivariable regression for new postoperative deficits were calculated. Eloquent region involved predominantly motor (45%) and language (40%). At first follow up after 3 months permanent neuro-logical deficits (NDs) were noted in 39%. Mild deficits remained in 29% and severe deficits in 10%. Complete tumor removal (CTR) was successfully in 62% of intended cases. Postoperative and 3-month follow up National Institute of Health Stroke Score (NIHSS) showed significantly lower values than preoperatively (p&lt;0.001). 38% cases showed a decreased NIHSS at 3-month, while occurrence was only 14% at 9-12-month follow up. 6/7 patients with mild aphasia recovered after 9-12 months, while motor deficits present at 3-month follow up were persistent in majority of patients. Eastern oncology group functional status (ECOG) significantly decreased by surgery (p &lt; 0.001) in 31% of cases. Between 3-month and 9-12-months follow up no significant improvement was seen. In the multivariable model CTR (p=0.019, OR 31.9), and ECOG&gt;0 (p=0.021, OR 8.5) were independent predictors for permanent postoperative deficit according to NIHSS at 3-month according to multivariable regression model. Patients harboring eloquently located LGG are highly vulnerable for permanent deficits. Almost one third of patients have a permanent reduction of their functional status based on ECOG. Risk of an extended resection has to be balanced with the respective oncological benefit. Especially, patients with impaired pre-operative status are at risk for new permanent deficits. There is a relevant improvement of neurological symptoms in the first year after surgery, especially for patients with slight aphasia.