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What effects does awake craniotomy have on functional and survival outcomes for glioblastoma patients?

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Abstract

Purpose

Neurosurgeons adopt several different surgical approaches to deal with glioblastomas (GB) located in or near eloquent areas. Some attempt maximal safe resection by awake craniotomy (AC), but doubts persist concerning the real benefits of this type of surgery in this situation. We performed a retrospective study to evaluate the extent of resection (EOR), functional and survival outcomes after AC of patients with GB in critical locations.

Methods

Forty-six patients with primary GB treated with the Stupp regimen between 2004 and 2019, for whom brain mapping was feasible, were included. We assessed EOR, postoperative language and/or motor deficits three months after AC, progression-free survival (PFS) and overall survival (OS).

Results

Complete resection was achieved in 61% of the 46 GB patients. The median PFS was 6.8 months (CI 6.1; 9.7) and the median OS was 17.6 months (CI 14.8; 34.1). Three months after AC, more than half the patients asymptomatic before surgery remained asymptomatic, and one third of patients with symptoms before surgery experienced improvements in language, but not motor functions. The risk of postoperative deficits was higher in patients with preoperative deficits or incomplete resection. Furthermore, the presence of postoperative deficits was an independent predictive factor for shorter PFS.

Conclusion

AC is an option for the resection of GB in critical locations. The observed survival outcomes are typical for GB patients in the Stupp era. However, the success of AC in terms of the recovery or preservation of language and/or motor functions cannot be guaranteed, given the aggressiveness of the tumor.

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Abbreviations

AC:

Awake craniotomy

EOR:

Extent of resection

GA:

General anesthesia

GB:

Glioblastoma

GTR:

Gross total resection

HGG:

High-grade glioma

HRQoL:

Health-related quality of life

IDH:

Isocitrate dehydrogenase

KPS:

Karnofsky performance status

LGG:

Low-grade glioma

LH:

Left hemisphere

OS:

Overall survival

RH:

Right hemisphere

PFS:

Progression-free survival

PR:

Partial resection

STR:

Subtotal resection

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Acknowledgements

We thank the neuroradiologists, neuropathologists, radiation oncologists and medical oncologists who followed the patients. We also thank Gwénaëlle Soulard and Nolwenn Madec for their help in the recovery and exploitation of data and Alex Edelman and Associates for correcting the manuscript.

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Authors and Affiliations

  1. Université d’Angers, CHU d’Angers, CRCINA, Angers, France

    Anne Clavreul, Jean-Michel Lemée & Philippe Menei

  2. Département de Neurochirurgie, CHU Angers, Angers, France

    Anne Clavreul, Matthieu Delion, Jean-Michel Lemée & Philippe Menei

  3. Département de Neurologie, CHU Angers, Angers, France

    Ghislaine Aubin

  4. Les Capucins, Centre de Rééducation et Réadaptation Fonctionnelle Adulte et Pédiatrique, Angers, France

    Ghislaine Aubin

  5. Département d’Anesthésie, CHU Angers, Angers, France

    Aram Ter Minassian

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  1. Anne Clavreul
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Correspondence to Philippe Menei.

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Clavreul, A., Aubin, G., Delion, M. et al. What effects does awake craniotomy have on functional and survival outcomes for glioblastoma patients?. J Neurooncol 151, 113–121 (2021). https://doi.org/10.1007/s11060-020-03666-7

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  • DOI: https://doi.org/10.1007/s11060-020-03666-7

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