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J Neurol Surg A Cent Eur Neurosurg 2018; 79(06): 453-463
DOI: 10.1055/s-0037-1617756
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Risk of Postoperative Performance Status Worsening after Resection of Lesions Involving the Motor Pathway: A Multinomial Logistic Regression Model

Antonino Raco
1   Azienda Universitaria Ospedaliera Sant'Andrea, Roma, Italy
2   Division of Neurosurgery, Department of NESMOS, “Sapienza” University, Roma, Italy
,
Alessandro Pesce
1   Azienda Universitaria Ospedaliera Sant'Andrea, Roma, Italy
2   Division of Neurosurgery, Department of NESMOS, “Sapienza” University, Roma, Italy
,
Flavia Fraschetti
1   Azienda Universitaria Ospedaliera Sant'Andrea, Roma, Italy
2   Division of Neurosurgery, Department of NESMOS, “Sapienza” University, Roma, Italy
,
Giancarlo D'Andrea
1   Azienda Universitaria Ospedaliera Sant'Andrea, Roma, Italy
,
Filippo Maria Polli
1   Azienda Universitaria Ospedaliera Sant'Andrea, Roma, Italy
2   Division of Neurosurgery, Department of NESMOS, “Sapienza” University, Roma, Italy
,
Michele Acqui
1   Azienda Universitaria Ospedaliera Sant'Andrea, Roma, Italy
2   Division of Neurosurgery, Department of NESMOS, “Sapienza” University, Roma, Italy
,
Alessandro Frati
3   Department of Neurosurgery, IRCCS “Neuromed” – Pozzilli (IS), Italy
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Publikationsverlauf

08. Dezember 2016

08. September 2017

Publikationsdatum:
09. März 2018 (online)

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Abstract

Background and Study Objective In surgery for gliomas and brain metastases, preservation of neurologic functions is essential to ensure a good quality of life and the eligibility for adjuvant therapies. This article assesses which factors could influence the functional outcome in patients with lesions located in the motor pathways.

Materials and Methods A total of 92 patients with gliomas and metastases involving the motor pathways were studied for concerns regarding quality of life (Karnofsky performance status [KPS] and modified Rankin scale [mRS]) before and after surgical treatment supported by intraoperative neuromonitoring. Patient-related, surgery-related, and lesion-related data were recorded to identify the relationships with postoperative performance status. The relationship between lesions and the corticospinal tract were investigated with preoperative magnetic resonance imaging sequences and tractographic reconstructions.

Results Means of preoperative mRS and KPS were 1.91 ± 1.34 and 80.8 ± 20, and at 30 days postoperatively they were 1.93 ± 1.63 and 79.8 ± 24.4, respectively. The better preoperative performance status was a predictor of better outcome in terms of quality of life. Gender showed a statistical association with ∆KPS (p = 0.033) and ∆mRS (p = 0.031). A recurrent lesion was a predictor of poor functional outcome (p= 0.045 for KPS at 30 days).A left-sided lesion showed a statistical association with a lesser improvement with respect to right sided. Complications were associated with a lesser functional improvement (∆mRS, ∆KPS, and clinical improvement: p = 0.001, p = 0.006, and p = 0.003, respectively). Hemorrhagic complications were associated with the worst functional prognosis.

Conclusions In our experience, factors associated with worse functional prognosis and quality of life were a poor preoperative performance status, female gender, operating on a recurrent lesion, involvement of the left corticospinal tract, and surgical or medical postoperative complications.

Keywords

primary motor cortex - corticospinal tract - quality of life - modified Rankin scale - Karnofsky performance status
 

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