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Updated: Jul 15, 2026
Primary Orthotopic Glioma Xenografts Recapitulate Infiltrative Growth and Isocitrate Dehydrogenase I Mutation
Published on: January 14, 2014
Functional and oncological outcomes following more than three consecutive surgical resections for multiple relapses
Anissa Nassihi1, Hugues Duffau2,3
1Department of Neurosurgery, University of Rouen, Rouen, France.
Background:
Second and third surgeries were demonstrated as safe and efficient in recurrent diffuse low-grade glioma (LGG). Here, the feasibility of more than 3 resections is investigated.
Methods:
Patients who underwent 4 or 5 operations for recurrent initially WHO grade 2 IDH-mutated gliomas were consecutively selected.
Results:
Twenty-three operations were performed in five patients (all males, mean age 27.2 ± 4 years). Three patients underwent 5 surgeries and two patients underwent 4 surgeries. Twelve procedures (52%) were achieved with awake mapping, including all 4th and 5th operations but one. Repeat electrical mapping detected changes of the cortical maps between at least two awake surgeries in 4 patients. No patients experienced permanent neurological impairment (KPS score ≥ 80 in all cases). The patients returned to work after 22 surgeries among 23 (95.6%). There were 3 oligodendrogliomas and 2 astrocytomas (4 gliomas became malignant at fourth or fifth operation). Although the preoperative tumor volume significantly increased before the fourth (p = 0.026) and fifth operation (p = 0.003) compared with the first operation, there was no significant difference between the residual tumor volume after the fourth or fifth resection versus the first one. The mean delay was 10.6 ± 3.9 years before chemotherapy and 15.4 ± 3.4 years before radiotherapy (one patient never received adjuvant treatment after 21.5 years). The mean follow-up duration was 18.3 ± 3.1 years since the first surgery (2.3 ± 1.8 years since the last surgery). Three patients were still alive at last follow-up.
Conclusions:
This is the first series showing that to reoperate beyond three times is feasible with a low functional risk and a long survival in multiple LGG recurrences, with the use of awake mapping in 87.5% of 4th and 5th surgeries.
Insights
Reoperating more than three times for diffuse low-grade glioma (LGG) is feasible and safe, offering a low functional risk and extended survival. Advanced techniques like awake mapping are crucial for these extensive resections.
Area of Science:
- Neurosurgery
- Oncology
- Neurology
Background:
- Second and third surgeries for recurrent diffuse low-grade glioma (LGG) are established as safe and effective.
- This study investigates the feasibility of performing more than three surgical resections for LGG.
Purpose of the Study:
- To assess the safety and efficacy of undergoing four or five surgical resections for recurrent diffuse low-grade gliomas.
- To evaluate functional outcomes and survival rates in patients with multiple LGG recurrences.
Main Methods:
- Consecutive selection of patients who underwent 4 or 5 operations for recurrent WHO grade 2 IDH-mutated gliomas.
- Utilized awake mapping in 52% of procedures, including most 4th and 5th surgeries, to monitor cortical maps.
Main Results:
- Twenty-three operations were performed on five patients (mean age 27.2 years); 3 had 5 surgeries, 2 had 4 surgeries.
- No permanent neurological deficits occurred (KPS ≥ 80); 95.6% of patients returned to work.
- Despite increased preoperative tumor volume, residual tumor volume post-resection did not significantly differ from the first surgery.
Conclusions:
- Reoperation beyond three times for multiple LGG recurrences is feasible with low functional risk and potential for long survival.
- Awake mapping is a key technique, used in 87.5% of 4th and 5th surgeries, contributing to favorable outcomes.
- This series demonstrates the viability of extensive surgical management for recurrent LGG, even after multiple previous operations.
