Application value of intraoperative electrophysiological monitoring in cerebral eloquent area glioma surgery: a retrospective cohort study
Abstract Introduction Surgery for gliomas involving eloquent areas is a very challenging microsurgical procedure. Maximizing both the extent of resection (EOR) and preservation of neurological function have always been the focus of attention. Intraoperative neurophysiological monitoring (IONM) is wi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Springer
2024-04-01
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| Series: | Discover Oncology |
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| Online Access: | https://doi.org/10.1007/s12672-024-00975-5 |
| _version_ | 1797209279301681152 |
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| author | Yuankun Liu Songyun Zhao Jin Huang Pengpeng Zhang Qi Wang Zhuwen Chen Lingjie Zhu Wei Ji Chao Cheng |
| author_facet | Yuankun Liu Songyun Zhao Jin Huang Pengpeng Zhang Qi Wang Zhuwen Chen Lingjie Zhu Wei Ji Chao Cheng |
| author_sort | Yuankun Liu |
| collection | DOAJ |
| description | Abstract Introduction Surgery for gliomas involving eloquent areas is a very challenging microsurgical procedure. Maximizing both the extent of resection (EOR) and preservation of neurological function have always been the focus of attention. Intraoperative neurophysiological monitoring (IONM) is widely used in this kind of surgery. The purpose of this study was to evaluate the efficacy of IONM in eloquent area glioma surgery. Methods Sixty-eight glioma patients who underwent surgical treatment from 2014 to 2019 were included in this retrospective cohort study, which focused on eloquent areas. Clinical indicators and IONM data were analysed preoperatively, two weeks after surgery, and at the final follow-up. Logistic regression, Cox regression, and Kaplan‒Meier analyses were performed, and nomograms were then established for predicting prognosis. The diagnostic value of the IONM indicator was evaluated by the receiver operating characteristic (ROC) curve. Results IONM had no effect on the postoperative outcomes, including EOR, intraoperative bleeding volume, duration of surgery, length of hospital stay, and neurological function status. However, at the three-month follow-up, the percentage of patients who had deteriorated function in the monitored group was significantly lower than that in the unmonitored group (23.3% vs. 52.6%; P < 0.05). Logistic regression analysis showed that IONM was a significant factor in long-term neurological function (OR = 0.23, 95% CI (0.07–0.70). In the survival analysis, long-term neurological deterioration indicated worsened overall survival (OS) and progression-free survival (PFS). A prognostic nomogram was established through Cox regression model analysis, which could predict the probability 3-year survival rate. The concordance index was 0.761 (95% CI 0.734–0.788). The sensitivity and specificity of IONM evoked potential (SSEP and TCeMEP) were 0.875 and 0.909, respectively. In the ROC curve analysis, the area under the curve (AUC) for the SSEP and TCeMEP curves was 0.892 (P < 0.05). Conclusions The application of IONM could improve long-term neurological function, which is closely related to prognosis and can be used as an independent prognostic factor. IONM is practical and widely available for predicting postoperative functional deficits in patients with eloquent area glioma. |
| first_indexed | 2024-04-24T09:52:10Z |
| format | Article |
| id | doaj.art-5f460581dfd54a78812efbe8d73c6b90 |
| institution | Directory Open Access Journal |
| issn | 2730-6011 |
| language | English |
| last_indexed | 2024-04-24T09:52:10Z |
| publishDate | 2024-04-01 |
| publisher | Springer |
| record_format | Article |
| series | Discover Oncology |
| spelling | doaj.art-5f460581dfd54a78812efbe8d73c6b902024-04-14T11:20:04ZengSpringerDiscover Oncology2730-60112024-04-0115111210.1007/s12672-024-00975-5Application value of intraoperative electrophysiological monitoring in cerebral eloquent area glioma surgery: a retrospective cohort studyYuankun Liu0Songyun Zhao1Jin Huang2Pengpeng Zhang3Qi Wang4Zhuwen Chen5Lingjie Zhu6Wei Ji7Chao Cheng8Department of Neurosurgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical UniversityDepartment of Neurosurgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical UniversityDepartment of Neurosurgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical UniversityDepartment of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and HospitalDepartment of Gastroenterology, Affiliated Hospital of Jiangsu UniversityDepartment of Functional Neurosurgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical UniversityDepartment of Pathophysiology, School of Medicine, Nantong UniversityDepartment of Neurosurgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical UniversityDepartment of Neurosurgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical UniversityAbstract Introduction Surgery for gliomas involving eloquent areas is a very challenging microsurgical procedure. Maximizing both the extent of resection (EOR) and preservation of neurological function have always been the focus of attention. Intraoperative neurophysiological monitoring (IONM) is widely used in this kind of surgery. The purpose of this study was to evaluate the efficacy of IONM in eloquent area glioma surgery. Methods Sixty-eight glioma patients who underwent surgical treatment from 2014 to 2019 were included in this retrospective cohort study, which focused on eloquent areas. Clinical indicators and IONM data were analysed preoperatively, two weeks after surgery, and at the final follow-up. Logistic regression, Cox regression, and Kaplan‒Meier analyses were performed, and nomograms were then established for predicting prognosis. The diagnostic value of the IONM indicator was evaluated by the receiver operating characteristic (ROC) curve. Results IONM had no effect on the postoperative outcomes, including EOR, intraoperative bleeding volume, duration of surgery, length of hospital stay, and neurological function status. However, at the three-month follow-up, the percentage of patients who had deteriorated function in the monitored group was significantly lower than that in the unmonitored group (23.3% vs. 52.6%; P < 0.05). Logistic regression analysis showed that IONM was a significant factor in long-term neurological function (OR = 0.23, 95% CI (0.07–0.70). In the survival analysis, long-term neurological deterioration indicated worsened overall survival (OS) and progression-free survival (PFS). A prognostic nomogram was established through Cox regression model analysis, which could predict the probability 3-year survival rate. The concordance index was 0.761 (95% CI 0.734–0.788). The sensitivity and specificity of IONM evoked potential (SSEP and TCeMEP) were 0.875 and 0.909, respectively. In the ROC curve analysis, the area under the curve (AUC) for the SSEP and TCeMEP curves was 0.892 (P < 0.05). Conclusions The application of IONM could improve long-term neurological function, which is closely related to prognosis and can be used as an independent prognostic factor. IONM is practical and widely available for predicting postoperative functional deficits in patients with eloquent area glioma.https://doi.org/10.1007/s12672-024-00975-5GliomaIntraoperative neurophysiological monitoringFunctionSurvivalRetrospective analysis |
| spellingShingle | Yuankun Liu Songyun Zhao Jin Huang Pengpeng Zhang Qi Wang Zhuwen Chen Lingjie Zhu Wei Ji Chao Cheng Application value of intraoperative electrophysiological monitoring in cerebral eloquent area glioma surgery: a retrospective cohort study Discover Oncology Glioma Intraoperative neurophysiological monitoring Function Survival Retrospective analysis |
| title | Application value of intraoperative electrophysiological monitoring in cerebral eloquent area glioma surgery: a retrospective cohort study |
| title_full | Application value of intraoperative electrophysiological monitoring in cerebral eloquent area glioma surgery: a retrospective cohort study |
| title_fullStr | Application value of intraoperative electrophysiological monitoring in cerebral eloquent area glioma surgery: a retrospective cohort study |
| title_full_unstemmed | Application value of intraoperative electrophysiological monitoring in cerebral eloquent area glioma surgery: a retrospective cohort study |
| title_short | Application value of intraoperative electrophysiological monitoring in cerebral eloquent area glioma surgery: a retrospective cohort study |
| title_sort | application value of intraoperative electrophysiological monitoring in cerebral eloquent area glioma surgery a retrospective cohort study |
| topic | Glioma Intraoperative neurophysiological monitoring Function Survival Retrospective analysis |
| url | https://doi.org/10.1007/s12672-024-00975-5 |
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