Acta Neurochirurgica

, Volume 155, Issue 1, pp 41–50

Cost-utility of maximal safe resection of WHO grade II gliomas within eloquent areas

  • Juan Martino
  • Elsa Gomez
  • José L. Bilbao
  • Juan C. Dueñas
  • Alfonso Vázquez-Barquero
Clinical Article - Brain Tumors



Despite the growing use of intraoperative electrical stimulation (IES) mapping for resection of WHO grade II gliomas (GIIG) located within eloquent areas, some authors claim that this is a complex, time-consuming and expensive approach, and not well tolerated by patients, so they rely on other mapping techniques. Here we analyze the health related quality of life, direct and indirect costs of surgeries with and without intraoperative electrical stimulation (IES) mapping for resection of GIIG within eloquent areas.


A cohort of 11 subjects with GIIG within eloquent areas who had IES while awake (group A) was matched by tumor side and location to a cohort of 11 subjects who had general anesthesia without IES (group B). Direct and indirect costs (measured as loss of labor productivity) and utility (measured in quality adjusted life years, QALYs), were compared between groups.


Total mean direct costs per patient were $38,662.70 (range $19,950.70 to $61,626.40) in group A, and $32,116.10 (range $22,764.50 to $46,222.50) in group B (p = 0.279). Total mean indirect costs per patient were $10,640.10 (range $3,010.10 to $86,940.70) in group A, and $48,804.70 (range $3,340.10 to $98,400.60) in group B (p = 0.035). Mean costs per QALY were $12,222.30 (range $3,801.10 to $47,422.90) in group A, and $31,927.10 (range $6,642.90 to $64,196.50) in group B (p = 0.023).


Asleep-awake-asleep craniotomies with IES are associated with an increase in direct costs. However, these initial expenses are ultimately offset by medium and long-term costs averted from a decrease in morbidity and preservation of the patient’s professional life. The present study emphasizes the importance to switch to an aggressive and safer surgical strategy in GIIG within eloquent areas.


Cost-utility Intraoperative electrical stimulation Surgery WHO grade II glioma 



Fluid-attenuated inversion recovery


WHO grade II glioma


Gross total resection




Incremental Cost-effectiveness Ratio


Intraoperative electrical stimulation


Karnofsky Performance Status






Magnetic resonance imaging


Near total resection


Positron emission tomography


Progression free survival


Subtotal resection


Quality adjusted life years


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Copyright information

© Springer-Verlag Wien 2012

Authors and Affiliations

  • Juan Martino
    • 1
    • 5
  • Elsa Gomez
    • 2
  • José L. Bilbao
    • 3
  • Juan C. Dueñas
    • 4
  • Alfonso Vázquez-Barquero
    • 1
  1. 1.Department of Neurological SurgeryHospital Universitario Marqués de Valdecilla and Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV)SantanderSpain
  2. 2.Department of PsychiatryHospital Universitario Marqués de ValdecillaSantanderSpain
  3. 3.Admission DepartmentHospital Universitario Marqués de ValdecillaSantanderSpain
  4. 4.Financial DepartmentHospital Universitario Marqués de ValdecillaSantanderSpain
  5. 5.Department of NeurosurgeryHospital Universitario Marqués de Valdecilla and Instituto de Formación e Investigación Marqués de Valdecilla (IFIMAV)SantanderSpain

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