Neurosurgery Resident Department of Neurosurgery, GHU Paris – Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
Disclosure(s):
Giorgia Antonia Simboli, MD: No financial relationships to disclose
Introduction: In order to obtain a maximal and safe resection in diffuse gliomas located within the superior frontal gyrus, it is necessary to identify the anatomical-functional margins of the lesion. The goal of this study is to define the extent of resection as a function of the anatomical proximity of eloquent cortico-subcortical areas, defining their functional limits, and its relationship with early post-operative deficits and long-term outcomes.
Methods: We conducted a retrospective, monocentric study at the Sainte-Anne hospital (Paris, France) between 2009 and 2022, including: 1) adult patients; 2) with diffuse gliomas located within the superior frontal gyrus; 3) operated for a maximal resection in awake conditions by direct electrical stimulation. All pre- and post-operative MRIs were normalized in the Montreal Neurological Institute model 152 space, using a transformation with Statistical Parametric Mapping 12 software and segmented with ITK-SNAP software to obtain the extent of resection.
Results: In all included patients (n=70), resection was obtained based on functional limits in all but one patient. The median duration of surgery was 225 minutes, with a median intensity of current stimulation of 3 mA. The average extension of the FLAIR hypersignal resection was 87.5%, and the average extension of the contrast medium resection was 99.5%. Immediate post-operative aggravation was found in 53/60 patients, with neurological deficit in 74.3%, of which 68.8% with motor and/or language deficit. 68.8% of patients were discharged from the hospital with a KPS≥80; 80% had a 3-month follow-up KPS≥90; 64% had a KPS of 100 at 6-months follow-up.
Conclusion : Function-based anatomical resection according to language, pre-motor, and motor pathway boundaries has been demonstrated to be feasible in patients harboring lesions within the superior frontal gyrus. We observe the post-operative clinical course with early deterioration and its recovery. Its correlation with quantitative extent of resection is being calculated.
