Abstract
Background To achieve maximal resection with minimal risk of postoperative neurologic morbidity,
different neurosurgical adjuncts are being used during low-grade glioma (LGG) surgery.
Objectives To investigate the effect of pre- and intraoperative adjuncts on the extent of resection
(EOR) of hemispheric LGGs.
Methods Medical records were reviewed to identify patients of any sex, ≥ 18 years of age,
who underwent LGG surgery at X Hospital between January 2005 and July 2013. Patients
were divided into eight subgroups based on the use of various combinations of a neuronavigation
system alone (NN), functional MRI-diffusion tensor imaging (fMRI-DTI) guided neuronavigation
(FD), intraoperative MRI (MR), and direct electrical stimulation (DES). Initial and
residual tumors were measured, and mean EOR was compared between groups.
Results Of all 128 patients, gross total resection was achieved in 23.4%. Overall mean EOR
was 81.3% ± 20.5%. Using DES in combination with fMRI-DTI (mean EOR: 86.7% ± 12.4%)
on eloquent tumors improved mean EOR significantly after adjustment for potential
confounders when compared with NN alone (mean EOR: 76.4% ± 25.5%; p = 0.001).
Conclusions Using DES in combination with fMRI and DTI significantly improves EOR when LGGs are
located in eloquent areas compared with craniotomies in which only NN was used.
Keywords
low-grade glioma - extent of resection - direct electrical stimulation - intraoperative
MRI - functional MRI-DTI
