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Is function-based resection using intraoperative awake brain mapping feasible and safe for solitary brain metastases within eloquent areas?

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Abstract

To assess feasibility and safety of function-based resection under awake conditions for solitary brain metastasis patients. Retrospective, observational, single-institution case-control study (2014-2019). Inclusion criteria are adult patients, solitary brain metastasis, supratentorial location within eloquent areas, and function-based awake resection. Case matching (1:1) criteria between metastasis group and control group (high-grade gliomas) are sex, tumor location, tumor volume, preoperative Karnofsky Performance Status score, age, and educational level. Twenty patients were included. Intraoperatively, all patients were cooperative; no obstacles precluded the procedure from being performed. A positive functional mapping was achieved at both cortical and subcortical levels, allowing for a function-based resection in all patients. The case-matched analysis showed that intraoperative and postoperative events were similar, except for a shorter duration of the surgery (p<0.001) and of the awake phase (p<0.001) in the metastasis group. A total resection was performed in 18 cases (90%, including 10 supramarginal resections), and a partial resection was performed in two cases (10%). At three months postoperative months, none of the patients had worsening of their neurological condition or uncontrolled seizures, three patients had an improvement in their seizure control, and seven patients had a Karnofsky Performance Status score increase ≥10 points. Function-based resection under awake conditions preserving the brain connectivity is feasible and safe in the specific population of solitary brain metastasis patients and allows for high resection rates within eloquent brain areas while preserving the overall and neurological condition of the patients. Awake craniotomy should be considered to optimize outcomes in brain metastases in eloquent areas.

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Acknowledgments

The authors gratefully acknowledge the following (in alphabetical order): the surgical neuro-oncology team, and particularly Alissia Basquin-Sanz, Odile Rigaux-Viodé, and Sylvie Sicot; the department of Neurosurgery; the department of Neuropathology, and particularly Pascale Varlet; the department of Neuroradiology, and particularly Joseph Benzakoun, Olivier Naggara, Catherine Oppenheim and Jean-François Meder; the department of Neurophysiology, and particularly Martine Gavaret and Angela Marchi; the department of neuro-anesthesia and neuro-intensive care, and particularly Abderrezak Akhrouf, Roland Benichou, Serge Biou, Mathieu Daniel, Hortense Dumontier, Aurélie Gruner, Aurélien Mazeraud, Alain Monpetit, Xavier Sauvageon, Caroline Schimpf, Alain Sermet, Tarek Sharshar, and Gilles Thouvenot; the neuro-oncology unit of the Gustave Roussy University Hospital, Villejuif, France, and particularly Sarah Dumont.

Author information

Author notes

  1. Jean-Baptiste Pelletier and Alessandro Moiraghi contributed equally to this work.

Authors and Affiliations

  1. Service de Neurochirurgie, GHU Paris, Hôpital Sainte-Anne, 1, rue Cabanis, F-75014, Paris, France

    Jean-Baptiste Pelletier, Alessandro Moiraghi, Marc Zanello, Alexandre Roux, Bénédicte Trancart, Gilles Zah-Bi, Eduardo Parraga, Edouard Dezamis & Johan Pallud

  2. Université de Paris, F-75006, Paris, France

    Jean-Baptiste Pelletier, Alessandro Moiraghi, Marc Zanello, Alexandre Roux, Bénédicte Trancart, Myriam Edjlali, Emmanuele Lechapt, Arnault Tauziede-Espariat, Gilles Zah-Bi, Eduardo Parraga, Fabrice Chretien, Edouard Dezamis & Johan Pallud

  3. Service de Neurochirurgie, CHU de Saint Etienne, Saint Etienne, France

    Jean-Baptiste Pelletier

  4. Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland

    Alessandro Moiraghi

  5. Swiss Foundation for Innovation and Training in Surgery (SFITS), Geneva, Switzerland

    Alessandro Moiraghi

  6. INSERM UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France

    Marc Zanello, Alexandre Roux, Myriam Edjlali & Johan Pallud

  7. Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA

    Sophie Peeters

  8. Service de Neuroradiologie, GHU Paris, Hôpital Sainte-Anne, F-75014, Paris, France

    Myriam Edjlali

  9. Service de Neuropathologie, GHU Paris, Hôpital Sainte-Anne, F-75014, Paris, France

    Emmanuele Lechapt, Arnault Tauziede-Espariat & Fabrice Chretien

  10. Service de Radiothérapie, Gustave Roussy University Hospital, Villejuif, France

    Frédéric Dhermain

Authors
  1. Jean-Baptiste Pelletier
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  2. Alessandro Moiraghi
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  3. Marc Zanello
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  6. Bénédicte Trancart
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  9. Arnault Tauziede-Espariat
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  10. Gilles Zah-Bi
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  15. Johan Pallud
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Contributions

JBP, AM, BT, ME, EL, ATE, ED, and JP did the data collection. JBP, AM, and JP did the data analysis. JBP, AM, MZ, AR, SP, BT, ME, EL, ATE, GZB, EP, FC, ED, FD, and JP did the data interpretation. JBP, AM, SP, and JP wrote the report. JBP, AM, MZ, AR, SP, BT, ME, EL, ATE, GZB, EP, FC, ED, FD, and JP reviewed and approved the paper.

Corresponding author

Correspondence to Johan Pallud.

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This study received approval (IRB#1: 2020/10) from the institutional review board (IRB00011687).

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Due to the retrospective nature of the study no consent was obtained.

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The authors have no conflict of interest to disclose.

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Pelletier, JB., Moiraghi, A., Zanello, M. et al. Is function-based resection using intraoperative awake brain mapping feasible and safe for solitary brain metastases within eloquent areas?. Neurosurg Rev 44, 3399–3410 (2021). https://doi.org/10.1007/s10143-021-01504-6

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  • DOI: https://doi.org/10.1007/s10143-021-01504-6

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