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Multilobar Insular-Involving Gliomas: Results with Hyperaggressive Resection
Michael Sughrue1, Phillip A Bonney1, Joshua D Burks1
1Department of Neurosurgery, University of Oklahoma Health Sciences Center.
Cureus
|November 4, 2017
Summary
Hyperaggressive surgery for multilobar insular-involving gliomas (MIGs) achieves high resection rates and acceptable neurologic deficits. This approach can lead to better long-term survival than standard treatments.
Area of Science:
- Neurosurgery
- Oncology
Background:
- Hyperaggressive resection is a surgical philosophy aiming for maximal tumor removal in gliomas.
- Multilobar insular-involving gliomas (MIGs) present unique surgical challenges due to their complex location.
Purpose of the Study:
- To report outcomes of hyperaggressive surgical resection for MIGs.
- To identify risk factors for neurologic deficits and survival in these patients.
Main Methods:
- Retrospective analysis of 72 consecutive patients with MIGs undergoing surgery.
- Aiming for gross total resection in all cases.
- Logistic and Cox regression used to model risk factors for outcomes.
Main Results:
- 93% achieved >90% resection; 43% had improved Karnofsky performance status (KPS) postoperatively.
- Survival rates varied by grade: Grade 2 (83% survival), Grade 3 (75% 2-year, 48% 4-year), Grade 4 (55% 1-year, 33% 2-year).
- Permanent deficits: 17% weakness, 13% speech problems (left-sided tumors).
Conclusions:
- Hyperaggressive resection of MIGs yields acceptable neurologic deficit rates, often lower than anticipated.
- This surgical approach can improve long-term survival beyond conventional treatment expectations.
