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Awake surgery for glioblastoma can preserve independence level, but is dependent on age and the preoperative condition

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Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Lately, awake surgery has been frequently adapted for glioblastoma (GBM). However, even with awake surgery, the expected long-term independence levels may not be achieved. We studied the characteristics of independence levels in GBM patients, and investigated the usefulness and parameter thresholds of awake surgery from the standpoint of functional outcomes.

Methods

Totally, 60 GBM patients (awake group, n = 30; general anesthesia group, n = 30) who underwent tumor resection surgery were included. We collected preoperative and 1- and 3-month postoperative Karnofsky Performance Status (KPS) scores, and analyzed causes of low KPS scores from the aspect of function, brain region, and clinical factors. Then, we focused on the operative method, and investigated the usefulness of awake surgery. Finally, we explored the parameter standards of awake surgery in GBM considering independence levels.

Results

Postoperative KPS were significantly lower than preoperative scores. Responsible lesions for low KPS scores were deep part of the left superior temporal gyrus and the right posterior temporal gyri that may be causes of aphasia and neuropsychological dysfunctions, respectively. Additionally, operative methods influenced on low independence level; long-term KPS scores in the awake group were significantly higher than those in the general anesthesia group, but they depended on age and preoperative KPS scores. Receiver operating characteristic curve analysis showed preoperative KPS = 90 and age = 62 years as the cutoff values for preservation of long-term KPS scores in awake group.

Conclusion

Awake surgery for GBM is useful for preserving long-term independence levels, but outcomes differ depending on age and preoperative KPS scores.

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Funding

This work was supported by JSPS KAKENHI Grant Number 18H03126.

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Authors and Affiliations

  1. Department of Occupational Therapy, Faculty of Health Science, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan

    Riho Nakajima

  2. Department of Neurosurgery, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan

    Masashi Kinoshita & Mitsutoshi Nakada

  3. Department of Physical Medicine and Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan

    Hirokazu Okita & Tetsutaro Yahata

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  1. Riho Nakajima
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  2. Masashi Kinoshita
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  4. Tetsutaro Yahata
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  5. Mitsutoshi Nakada
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Contributions

Author contributions to the study and manuscript preparation include the following. Conception and design: MN, RN. Acquisition of data: RN. Analysis and interpretation of data: RN, MK. Drafting article: MN, RN. Critically revising the article: all authors. Reviewed final version of the manuscript and approved it for submission: all authors. Study supervision: MN.

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Correspondence to Mitsutoshi Nakada.

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Supplementary Figure 1- Inclusion criteria for awake surgery group. Supplementary file1 (TIFF 795 kb)

11060_2019_3216_MOESM2_ESM.tiff

Supplementary Figure 2- Time course of Karnofsky Performance Status (KPS) scores. KPS at 1 and 3 months postoperatively were significantly lower than those pre-operatively (p = 0.0090, p = 0.015, respectively). Red line, mean; blue line, standard deviation; * < 0.05; ** < 0.01. Supplementary file2 (TIFF 757 kb)

11060_2019_3216_MOESM3_ESM.tiff

Supplementary Figure 3- Difference of KPS scores in both group. When difference of KPS scores between pre- and postoperative 3 month were compared, general anesthesia group was significantly lower than awake surgery group (p = 0.032). Notably, even in awake surgery group, independence level of some patients were declined. Red line, mean; blue line, standard deviation; * < 0.05. Supplementary file3 (TIFF 504 kb)

Supplementary file4 (DOCX 19 kb)

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Nakajima, R., Kinoshita, M., Okita, H. et al. Awake surgery for glioblastoma can preserve independence level, but is dependent on age and the preoperative condition. J Neurooncol 144, 155–163 (2019). https://doi.org/10.1007/s11060-019-03216-w

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  • DOI: https://doi.org/10.1007/s11060-019-03216-w

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