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Awake craniotomy for gliomas involving motor-related areas: classification and function recovery

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Motor mapping with direct cortical stimulation (DCS) is useful for motor function preservation. Nevertheless, many patients still experience postoperative motor dysfunction after motor mapping. This study aimed to provide a classification of gliomas involved in motor-related areas to help understand which types of gliomas are prone to induce postoperative motor impairments.

Methods

Sixty-four patients were retrospectively recruited. Based on tumor location, four types of gliomas were identified: (I) precentral gyrus; (II) premotor and/or supplementary motor areas but not invading pre-central gyrus; (III) adjacent to the posterior limb of the internal capsule; and (IV) other supra-tentorial area. The recovery of motor function was evaluated by muscle strength testing before surgery and 3 days, 7 days, 14 days, and 3 months after surgery.

Results

Half of the patients experienced postoperative transient motor impairment within a week. Six patients suffered from permanent motor dysfunction, and four of them had type III glioma. Compared with types I and IV, patients with type III gliomas took more than three times as long to recover. Furthermore, patients with types I and II gliomas were more susceptible to preoperative epilepsy than those with types III and IV. There was no difference in postoperative seizure control between the four types.

Conclusions

Our classification of gliomas involving motor-related eloquent areas was useful for predicting postoperative motor functional prognosis in patients who underwent motor mapping with DCS. Even if no positive sites were detected, a conservative strategy of tumor resection is recommended in cases that gliomas located close to the posterior limb of the internal capsule.

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Data availability

Anonymized data will be available on request.

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Acknowledgements

This study has received funding by the National High Technology Research and Development Program of China (863 Program, 2015AA020504), the National Basic Research Program of China (2015CB755500), and the National Natural Science Foundation of China (81601452).

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119, The Western Road of the Southern 4th Ring Road, Beijing, 100070, China

    Shengyu Fang, Yiming Li, Yinyan Wang, Zhong Zhang & Tao Jiang

  2. Beijing Neurosurgical Institute, Capital Medical University, Beijing, China

    Shengyu Fang & Tao Jiang

  3. Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China

    Tao Jiang

Authors
  1. Shengyu Fang
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  2. Yiming Li
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  4. Zhong Zhang
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Contributions

Study concept and design: FSY and LYM. Data acquisition and analysis: FSY and LYM. Statistics/verified analytical method: FSY, LYM, ZZ, and WYY. Writing the first draft: FSY, LYM, and WYY. Supervision: ZZ, WYY, and JT. Read and approved final version: all authors.

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Correspondence to Yinyan Wang, Zhong Zhang or Tao Jiang.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Ethical approval for this retrospective study was received from the Local Institutional Review Board

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Dr. Yinyan Wang, Zhong Zhang and Tao Jiang were equal corresponding to this manuscript.

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Fang, S., Li, Y., Wang, Y. et al. Awake craniotomy for gliomas involving motor-related areas: classification and function recovery. J Neurooncol 148, 317–325 (2020). https://doi.org/10.1007/s11060-020-03520-w

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  • DOI: https://doi.org/10.1007/s11060-020-03520-w

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