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Re-operation is a safe and effective therapeutic strategy in recurrent WHO grade II gliomas within eloquent areas

  • Clinical Article
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Abstract

Background

To analyze the functional and oncological results after re-operation for recurrent WHO grade II Glioma located in eloquent regions.

Method

We reviewed a consecutive series of 19 patients with GIIG within functional areas who underwent two operations separated by at least 1 year. Intraoperative electrical stimulation mapping was used in all operations for recurrence and in 14 of the initial procedures. A specific rehabilitation was provided.

Findings

At the first operation, we performed 14 subtotal and 5 partial resections. Eighteen patients returned to a normal socio-professional life. Nine patients received adjuvant treatment. At the second operation, we performed 1 total, 13 subtotal and 5 partial resections. Three patients with a preoperative neurological deficit improved, 13 remained unchanged, and 3 slight new deficits appeared. In 14 of the 17 patients with preoperative chronic epilepsy, the seizures were reduced or disappeared. Sixteen patients returned to a normal socio-professional life. Pathohistological examination showed that 11 tumours had progressed to high-grade glioma. The median time between the two operations was 4.1 years (range 1 to 7.8 years) and the median follow-up from initial diagnosis was 6.6 years (range 2.3 to 14.3 years). No deaths occurred during the follow-up period.

Conclusions

Repeat operations guided by intra-operative electrical stimulation is an efficacious treatment for recurrent grade II glioma in an eloquent area.

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Abbreviations

GIIG:

World Health Organization grade II glioma

IES:

intraoperative electrical stimulation

MRI:

magnetic resonance imaging

PET:

positron emission tomography

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Av de Valdecilla s/n, Santander, Cantabria, Spain

    Juan Martino

  2. Department of Neurology, CHU Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France

    Luc Taillandier

  3. Department of Neurology, Hôpital Gui de Chauliac, CHU Montpellier, 80 Av Augustin Fliche, 34295, Montpellier, France

    Sylvie Moritz-Gasser

  4. Laboratoire de Psychologie et de Neurosciences Cognitives, UMR 8189 (CNRS/ Université de Paris V René Descartes), Institut de Psychologie, 71 avenue Edouard Vaillant, 92774, Boulogne Billancourt, France

    Peggy Gatignol & Hugues Duffau

  5. Department of Neurosurgery, Hôpital Gui de Chauliac, CHU de Montpellier, 80 avenue Augustin Fliche, 34295, Montpellier, France

    Hugues Duffau

Authors
  1. Juan Martino
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  2. Luc Taillandier
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  3. Sylvie Moritz-Gasser
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  4. Peggy Gatignol
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  5. Hugues Duffau
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Corresponding author

Correspondence to Hugues Duffau.

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Comment

This is another very informative paper from Hugues Duffau’s research team on the topic of surgery for low grade glioma. This paper evaluates an increasingly important issue—that is should re-do surgery be done if a low grade glioma is progressing. The results show that using surgical diligence and intraoperative cortical and subcortical mapping in awake patients such surgery can be done with acceptable morbidity. The findings from second pathological examination also show a high percentage of dedifferentiation from original tumour pathology, in keeping with the development of focal contrast enhancement within the tumour.

Ian Whittle

University of Edinburgh, Scotland

Sources of financial support

Juan Martino receives specific founding from the Post-MIR Wenceslao López-Albo’s grant. Fundación “Marqués de Valdecilla”, IFIMAV, Santander, Cantabria, Spain.

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Martino, J., Taillandier, L., Moritz-Gasser, S. et al. Re-operation is a safe and effective therapeutic strategy in recurrent WHO grade II gliomas within eloquent areas. Acta Neurochir 151, 427–436 (2009). https://doi.org/10.1007/s00701-009-0232-6

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  • DOI: https://doi.org/10.1007/s00701-009-0232-6

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