Journal of neurological surgery. Part A, Central European neurosurgery · 2026
Role of Multimodal Use of Surgery Adjuncts for Overall Survival of Patients with Supratentorial WHO Grade 4 Gliomas.
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Czernicki Tomasz, Maj Edyta, Kunert Przemysław
Аннотация
BACKGROUND: In recent years, numerous advanced techniques supporting surgery (TSS) have been utilized to maximize glioma resection. However, the impact of the multimodal use of TSS, such as awake surgery, intraoperative neurophysiological monitoring, neuronavigation, fluorescence-guided surgery, functional magnetic resonance imaging m(fMRI), and diffusion tensor tractography (DTT), on improving overall survival (OS) remains uncertain.
METHODS: In retrospective analysis of 81 patients with supratentorial WHO grade 4 gliomas, we assessed the effect of age, sex, tumor location, number of TSS used, extent of resection (EOR), postoperative Karnofsky performance scale (KPS), IDH1 status, and use of postoperative adjuvant therapy (PAT), i.e., radiotherapy and chemotherapy, on overall survival. Kaplan-Meyer plots with F-Cox test and Cox proportional hazards model were used for univariate and multivariate survival analyses.
RESULTS: We used none, one, two, three, or four TSS in 30, 20, 15, 9, and 7 patients, respectively. The number of TSS used (none vs. 1-2 vs. 3-4) correlated with OS in eloquent areas (p = 0.029, univariate; p = 0.006, multivariate) with median survival of 194, 364, and 674 days, respectively, whereas no correlation was observed in non-eloquent areas. In univariate analysis but not in multivariate analysis, significant factors for OS in gliomas in eloquent areas were younger age (p = 0.026), EOR (gross total vs. subtotal vs. partial resection) (p = 0.015), and PAT use (p = 0.00066), and in gliomas in non-eloquent areas were EOR (p = 0.01), postoperative KPS (≥70 vs. <70) (p = 0.023), and PAT use (p = 0.015).
CONCLUSION: The simultaneous use of multiple TSS appears to be associated with improved overall survival in patients with supratentorial WHO grade 4 gliomas in eloquent areas, in contrast to non-eloquent areas.
METHODS: In retrospective analysis of 81 patients with supratentorial WHO grade 4 gliomas, we assessed the effect of age, sex, tumor location, number of TSS used, extent of resection (EOR), postoperative Karnofsky performance scale (KPS), IDH1 status, and use of postoperative adjuvant therapy (PAT), i.e., radiotherapy and chemotherapy, on overall survival. Kaplan-Meyer plots with F-Cox test and Cox proportional hazards model were used for univariate and multivariate survival analyses.
RESULTS: We used none, one, two, three, or four TSS in 30, 20, 15, 9, and 7 patients, respectively. The number of TSS used (none vs. 1-2 vs. 3-4) correlated with OS in eloquent areas (p = 0.029, univariate; p = 0.006, multivariate) with median survival of 194, 364, and 674 days, respectively, whereas no correlation was observed in non-eloquent areas. In univariate analysis but not in multivariate analysis, significant factors for OS in gliomas in eloquent areas were younger age (p = 0.026), EOR (gross total vs. subtotal vs. partial resection) (p = 0.015), and PAT use (p = 0.00066), and in gliomas in non-eloquent areas were EOR (p = 0.01), postoperative KPS (≥70 vs. <70) (p = 0.023), and PAT use (p = 0.015).
CONCLUSION: The simultaneous use of multiple TSS appears to be associated with improved overall survival in patients with supratentorial WHO grade 4 gliomas in eloquent areas, in contrast to non-eloquent areas.