Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026
Subventricular zone involvement and cortico-spinal tract infiltration as predictors of outcome in Glioblastomas: a distinct surgical, clinical and prognostic entity.
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Giorgia Iovannitti, Mauro Palmieri, Lorenzo Aureli, Federica Novegno, Tamara Ius, Valerio Da Ros, Daniele Armocida, Antonio Santoro, Maurizio Salvati, Alessandro Frati, Alessandro Pesce
Аннотация
BACKGROUND: Glioblastomas (GBMs) involving the subventricular zone (SVZ) and eloquent motor pathways represent a major surgical and prognostic challenge. While SVZ contact and motor-area involvement have been independently associated with poor outcome, the combined prognostic impact remains poorly defined.
METHODS: We retrospectively analyzed 200 consecutive patients with newly diagnosed IDH-wildtype GBM treated between 2018 and 2024. Four anatomical subgroups were identified: non-motor/non-SVZ (n = 79), non-motor/SVZ (n = 75), motor/non-SVZ (n = 34), and motor/SVZ (n = 10). Overall survival (OS), progression-free survival (PFS), extent of resection (EOR), and functional outcome assessed by Karnofsky Performance Status (KPS) were compared using Kaplan-Meier analysis, Cox regression, and longitudinal mixed-effects modelling.
RESULTS: The lowest gross-total resection rate was observed across the motor/SVZ subgroup (50%; p = 0.008). Median OS and PFS were significantly shorter in the motor/SVZ subgroup (OS 6.0 months; PFS 1.0 months) compared with the other anatomical groups (OS 11.0-15.0 months; PFS 4.0-7.5 months; OS p = 0.020, PFS p = 0.043). In multivariable Cox analysis, combined motor and SVZ involvement was independently associated with reduced OS (HR 4.82, 95% CI 1.02-22.74, p = 0.047). Patients with motor/SVZ tumors consistently exhibited the lowest postoperative and follow-up KPS values, indicating persistently worse functional status. The adverse prognostic effect of motor/SVZ involvement was confirmed in sensitivity analyses.
CONCLUSIONS: GBMs involving both eloquent motor pathways and the SVZ may represent a high-risk anatomical subgroup associated with reduced resectability, poorer postoperative functional recovery, and shorter survival. Given the small motor/SVZ sample size, these findings should be considered hypothesis-generating and require validation in larger multicentric cohorts. Nevertheless, they support the potential value of integrating anatomical and functional parameters in surgical decision-making and prognostic stratification.
METHODS: We retrospectively analyzed 200 consecutive patients with newly diagnosed IDH-wildtype GBM treated between 2018 and 2024. Four anatomical subgroups were identified: non-motor/non-SVZ (n = 79), non-motor/SVZ (n = 75), motor/non-SVZ (n = 34), and motor/SVZ (n = 10). Overall survival (OS), progression-free survival (PFS), extent of resection (EOR), and functional outcome assessed by Karnofsky Performance Status (KPS) were compared using Kaplan-Meier analysis, Cox regression, and longitudinal mixed-effects modelling.
RESULTS: The lowest gross-total resection rate was observed across the motor/SVZ subgroup (50%; p = 0.008). Median OS and PFS were significantly shorter in the motor/SVZ subgroup (OS 6.0 months; PFS 1.0 months) compared with the other anatomical groups (OS 11.0-15.0 months; PFS 4.0-7.5 months; OS p = 0.020, PFS p = 0.043). In multivariable Cox analysis, combined motor and SVZ involvement was independently associated with reduced OS (HR 4.82, 95% CI 1.02-22.74, p = 0.047). Patients with motor/SVZ tumors consistently exhibited the lowest postoperative and follow-up KPS values, indicating persistently worse functional status. The adverse prognostic effect of motor/SVZ involvement was confirmed in sensitivity analyses.
CONCLUSIONS: GBMs involving both eloquent motor pathways and the SVZ may represent a high-risk anatomical subgroup associated with reduced resectability, poorer postoperative functional recovery, and shorter survival. Given the small motor/SVZ sample size, these findings should be considered hypothesis-generating and require validation in larger multicentric cohorts. Nevertheless, they support the potential value of integrating anatomical and functional parameters in surgical decision-making and prognostic stratification.