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Practical surgical indicators to identify candidates for radical resection of insulo-opercular gliomas
Tomohiro Kawaguchi1, Toshihiro Kumabe, Ryuta Saito
1Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Object:
Maximum resection of gliomas with minimum surgical complications usually leads to optimum outcomes for patients. Radical resection of insulo-opercular gliomas is still challenging, and selection of ideal patients can reduce risk and obtain better outcomes.
Methods:
This retrospective study included 83 consecutively treated patients with newly diagnosed gliomas located at the insulo-opercular region and extending to the sylvian fissure around the primary motor and somatosensory cortices. The authors selected 4 characteristics as surgical indicators: clear tumor boundaries, negative enhancement, intact lenticulostriate arteries, and intact superior extremity of the central insular sulcus.
Results:
Univariate analysis showed that tumors with clear boundaries were associated with higher rates of gross-total resection than were tumors with ambiguous boundaries (75.7% vs 19.6%). Tumors with negative enhancement compared with enhanced tumors were associated with lower frequency of tumor progression (32.0% vs 81.8%, respectively) and lower rates of surgical complications (14.0% vs 45.5%, respectively). Tumors with intact lenticulostriate arteries were associated with higher rates of gross-total resection than were tumors with involved lenticulostriate arteries (67.3% vs 11.8%, respectively). Tumors with intact superior extremity of the central insular sulcus were associated with higher rates of gross-total resection (57.4% vs 20.7%, respectively) and lower rates of surgical complications (18.5% vs 41.4%, respectively) than were tumors with involved anatomical structures. Multivariate analysis showed that clear tumor boundaries were independently associated with gross-total resection (p < 0.001). Negative enhancement was found to be independently associated with surgical complications (p = 0.005), overall survival times (p < 0.001), and progression-free survival times (p = 0.004). Independent associations were also found between intact lenticulostriate arteries and gross-total resection (p < 0.001), between intact lenticulostriate arteries and progression-free survival times (p = 0.026), and between intact superior extremity of the central insular sulcus and gross-total resection (p = 0.043). Among patients in whom all 4 indicators were present, prognosis was good (5-year survival rate 93.3%), resection rate was maximal (gross-total resection 100%), and surgical complication rate was minimal (6.7%). Also among these patients, overall rates of survival (p = 0.003) and progression-free survival (p = 0.005) were significantly higher than among patients in whom fewer indicators were present.
Conclusions:
The authors propose 4 simple indicators that can be used to identify ideal candidates for radical resection of insulo-opercular gliomas, improve the outcomes, and promote maximum resection without introducing neurological complications. The indicators are clear tumor boundaries, negative enhancement, intact lenticulostriate arteries, and intact superior extremity of the central insular sulcus.
Insights
Identifying ideal patients for insulo-opercular glioma resection is key. Four indicators—clear boundaries, negative enhancement, intact arteries, and intact sulcus—predict maximal resection with minimal complications.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Radical resection of insulo-opercular gliomas is challenging.
- Patient selection is crucial for optimizing outcomes and minimizing surgical complications.
Purpose of the Study:
- To identify key indicators for selecting ideal candidates for radical resection of insulo-opercular gliomas.
- To improve surgical outcomes and maximize tumor resection while minimizing neurological deficits.
Main Methods:
- Retrospective study of 83 patients with newly diagnosed insulo-opercular gliomas.
- Evaluation of four surgical indicators: clear tumor boundaries, negative enhancement, intact lenticulostriate arteries, and intact superior extremity of the central insular sulcus.
Main Results:
- Clear tumor boundaries, negative enhancement, intact lenticulostriate arteries, and intact superior central insular sulcus were associated with higher gross-total resection rates.
- Negative enhancement correlated with lower tumor progression and fewer surgical complications.
- Presence of all four indicators predicted maximal resection (100%), minimal complications (6.7%), and superior survival rates (93.3% 5-year survival).
Conclusions:
- Four indicators can effectively identify ideal candidates for radical resection of insulo-opercular gliomas.
- These indicators facilitate maximal resection and improved patient outcomes with reduced neurological complications.
