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Surgical management of periventricular gliomas: grading system to preoperative assess of resectability
EANS Academy. Rozumenko A. Sep 26, 2019; 276012; EP03064
Abstract
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Objective: The purpose of the present study was to define the preoperative neuroimaging sighs as factors determining the early postoperative outcome in patients with high-grade periventricular gliomas (PVG)
Methods: The clinical records of 132 (50 females and 82 males) consecutive patients with mean age 45.9 years (range 21 - 69) undergoing image-guided surgery for PVG were retrospectively analyzed. There were 52 (39.4%) WHO grade III gliomas, and in 80 (60.6%) of patients WHO grade IV gliomas were found.
Results: Postoperative median KPS score significantly raised from 67.4 to 82.0, as well as, a number of patients with the KPS score ≥ 70: from 18 (13.6%) to 109 (82.6%) with p < 0.01. The multivariate regression analysis revealed that poor postoperative functional status was associated with basal ganglia involvement (OR 2.75, 95% CI 0.93-8.09, p = 0.07), the higher EOR grade (OR 3.30, 95% CI 1.15-9.43, p = 0.03), and hydrocephalus (OR 5.08, 95% CI 1.49-17.35, p = 0.09).
Total/subtotal resection was carried out in 84 (63.6%) cases; in other 48 (36.4%) cases, the partial resection was performed. The multivariate logistic regression analysis revealed that three factors decreased the likelihood of total/subtotal resection in PVG: basal ganglia invasion (OR 0.18, 95% CI 0.06 - 0.55, p < 0.01), minor extraventricular part (OR 0.40, 95% CI 0.17 - 0.94, p = 0.04), and contralateral side extension (OR 0.38, 95% CI 0.16 - 0.92, p = 0.03). The presence of tumor-associated cyst (OR 3,73, 95% CI 1.32 - 10.54, p = 0.01) increased odds of total/subtotal resection. The four-tear grading system of PVG including statistically identified factors for total/subtotal resection and risks of postoperative neurological deterioration were developed.
Conclusions: Proposed grading system provides the possibility of a preoperative evaluation of PVG resectability allows performing maximal safe resections and preventing of postoperative neurological deficits.
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