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Functional outcomes and survival in patients with high-grade gliomas in dominant and nondominant hemispheres

Richard S. Polin Department of Neurosurgery, School of Medicine, The George Washington University, Washington, DC; Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and University of Massachusetts Medical School, Worcester, Massachusetts

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Nicholas F. Marko Department of Neurosurgery, School of Medicine, The George Washington University, Washington, DC; Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and University of Massachusetts Medical School, Worcester, Massachusetts

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Matthew D. Ammerman Department of Neurosurgery, School of Medicine, The George Washington University, Washington, DC; Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and University of Massachusetts Medical School, Worcester, Massachusetts

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Mark E. Shaffrey Department of Neurosurgery, School of Medicine, The George Washington University, Washington, DC; Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and University of Massachusetts Medical School, Worcester, Massachusetts

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Wei Huang Department of Neurosurgery, School of Medicine, The George Washington University, Washington, DC; Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and University of Massachusetts Medical School, Worcester, Massachusetts

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Frederick A. Anderson Jr. Department of Neurosurgery, School of Medicine, The George Washington University, Washington, DC; Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and University of Massachusetts Medical School, Worcester, Massachusetts

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Anthony J. Caputy Department of Neurosurgery, School of Medicine, The George Washington University, Washington, DC; Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and University of Massachusetts Medical School, Worcester, Massachusetts

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Edward R. Laws Department of Neurosurgery, School of Medicine, The George Washington University, Washington, DC; Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and University of Massachusetts Medical School, Worcester, Massachusetts

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276–283
Volume/Issue:
Volume 102: Issue 2
DOI link:
https://doi.org/10.3171/jns.2005.102.2.0276
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Object. The goal of this study was to investigate survival and functional outcomes in patients with high-grade intracranial astrocytomas as a function of the location of the lesion in the dominant or nondominant hemisphere (DH and NDH, respectively), and to suggest management strategies for such patients based on these data.

Methods. Data were collected from the Glioma Outcomes Project database, a longitudinal database of demographic, clinical, and outcome data for patients with high-grade intracranial gliomas. From the entire database of 788 patients, a subset of all 280 right-handed patients with newly diagnosed, unilateral gliomas involving potentially eloquent cortex was selected as the sample population. Two cohorts were defined based on the location of the tumor in the right or left cerebral hemisphere. All other relevant demographic and clinical data were nearly identical between the cohorts. A Kaplan—Meier analysis was conducted to assess survival, and Karnofsky Performance Scale scores assigned at 6 and 12 months postoperatively were compared as a measure of functional outcome.

The analysis demonstrated no difference in survival between patients with lesions in the DH and those with tumors in the NDH. Additionally, no statistically significant difference in functional outcomes was observed between the two groups.

Conclusions. Laterality of high-grade gliomas is not an independent prognostic factor for predicting survival or functional outcome. The findings in this study demonstrate that fears of increased postoperative morbidity or mortality in otherwise resectable tumors of the DH are unfounded, and the authors therefore advocate that the surgeon's decision to operate be guided by validated outcome predictors and not biased by tumor lateralization.

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Contributor Notes

Address reprint requests to: Richard S. Polin, M.D., Department of Neurosurgery, The George Washington University, 2150 Pennsylvania Avenue, NW, Suite 7—419, Washington, DC 20037. email: rpolin@mfa.gwu.edu.
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