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Functional mapping–guided resection of low-grade gliomas in eloquent areas of the brain: improvement of long-term survival

Clinical article

Edward F. Chang Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D.
,
Aaron Clark Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D., Ph.D.
,
Justin S. Smith Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D., Ph.D.
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Mei-Yin Polley Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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 Ph.D.
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Susan M. Chang Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Nicholas M. Barbaro Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D.
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Andrew T. Parsa Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Michael W. McDermott Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D.
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Mitchel S. Berger Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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 M.D.
Page Range:
566–573
Volume/Issue:
Volume 114: Issue 3
DOI link:
https://doi.org/10.3171/2010.6.JNS091246
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Object

Low-grade gliomas (LGGs) frequently infiltrate highly functional or “eloquent” brain areas. Given the lack of long-term survival data, the prognostic significance of eloquent brain tumor location and the role of functional mapping during resective surgery in presumed eloquent brain regions are unknown.

Methods

We performed a retrospective analysis of 281 cases involving adults who underwent resection of a supratentorial LGG at a brain tumor referral center. Preoperative MR images were evaluated blindly for involvement of eloquent brain areas, including the sensorimotor and language cortices, and specific subcortical structures. For high-risk tumors located in presumed eloquent brain areas, long-term survival estimates were evaluated for patients who underwent intraoperative functional mapping with electrocortical stimulation and for those who did not.

Results

One hundred and seventy-four patients (62%) had high-risk LGGs that were located in presumed eloquent areas. Adjusting for other known prognostic factors, patients with tumors in areas presumed to be eloquent had worse overall and progression-free survival (OS, hazard ratio [HR] 6.1, 95% CI 2.6–14.1; PFS, HR 1.9, 95% CI 1.2–2.9; Cox proportional hazards). Confirmation of tumor overlapping functional areas during intraoperative mapping was strongly associated with shorter survival (OS, HR 9.6, 95% CI 3.6–25.9). In contrast, when mapping revealed that tumor spared true eloquent areas, patients had significantly longer survival, nearly comparable to patients with tumors that clearly involved only noneloquent areas, as demonstrated by preoperative imaging (OS, HR 2.9, 95% CI 1.0–8.5).

Conclusions

Presumed eloquent location of LGGs is an important but modifiable risk factor predicting disease progression and death. Delineation of true functional and nonfunctional areas by intraoperative mapping in high-risk patients to maximize tumor resection can dramatically improve long-term survival.

Abbreviations used in this paper:

HR = hazard ratio; HSD = honestly significant difference; KPS = Karnofsky Performance Scale; LGG = low-grade glioma; OS = overall survival; PFS = progressionfree survival; UCSF = University of California, San Francisco.
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Contributor Notes

Address correspondence to: Edward F. Chang, M.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, California 94143. email: ChangEd@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online July 16, 2010; DOI: 10.3171/2010.6.JNS091246.

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