Role of patient frailty in resection of newly diagnosed motor eloquent glioblastomas guided by a navigated transcranial magnetic stimulation and tractography approach.

IF 3.1 2区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuro-Oncology Pub Date : 2025-12-01 Epub Date: 2025-09-09 DOI:10.1007/s11060-025-05206-7

Thomas Eibl, Adrian Liebert, Leonard Ritter, Markus Neher, Karl-Michael Schebesch

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引用次数: 0

Abstract

Purpose: Resection of glioblastomas infiltrating the motor cortex and corticospinal tract (CST) is often linked to increased perioperative morbidity. Navigated transcranial magnetic stimulation (nTMS) motor mapping has been advocated to increase patient safety in these cases. The additional impact of patient frailty on overall outcome after resection of cases with increased risk for postoperative motor deficits as identified with nTMS needs to be investigated.

Methods: Patients with newly diagnosed motor eloquent glioblastomas were retrospectively evaluated. Patients underwent nTMS- and tractography-based neuronavigation. Demographic, imaging- and nTMS-derived data and the 11-item modified frailty index (mFI-11) were collected. Primary endpoint was discharge home after tumor resection. A 4-item score comprising preoperative motor deficit, mFI-11 ≥ 2 points, distance to the CST < 12 mm and infiltration of nTMS-positive cortex was established to predict overall outcome.

Results: N = 64 patients with a mean age of 64.8 ± 9.6 years (60.9% male) were included. 46 patients (71.9%) could be discharged to their homes. Risk factors for non-home discharge were greater mFI-11 (p = 0.027), surgery-related motor deficit (p < 0.001) and overall complications (p < 0.001 for non-surgical and p = 0.006 for surgical complications). In multiple regression analyses, mFI-11 and surgery-related deficit were statistically robust. The 4-item score predicted non-home discharge with an AUC = 0.745, 95%CI = 0.62-0.87, p < 0.001.

Conclusion: In patients with newly diagnosed motor-eloquent glioblastomas, nTMS-based planning helps to predict postoperative surgery-related motor deficits. Patient frailty needs to be respected in decision making in addition to nTMS- and tractography-based planning in order to avoid postsurgical motor deficits and to keep overall surgical morbidity on a low level.

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经颅磁刺激和神经束造影引导下患者虚弱在新诊断的运动性胶质母细胞瘤切除术中的作用。

目的：浸润运动皮质和皮质脊髓束（CST）的胶质母细胞瘤切除术通常与围手术期发病率增加有关。导航经颅磁刺激（nTMS）运动定位已被提倡，以提高患者在这些情况下的安全性。患者虚弱对术后运动功能障碍风险增加的病例切除后总体结果的额外影响需要调查。方法：对新诊断的运动雄辩胶质母细胞瘤患者进行回顾性分析。患者接受nTMS和神经束图为基础的神经导航。收集人口统计学、影像学和ntms数据以及11项修正虚弱指数（mFI-11）。主要终点为肿瘤切除后出院。4项评分包括术前运动缺陷、mFI-11≥2分、与CST的距离。结果：N = 64例患者，平均年龄64.8±9.6岁（男性60.9%）。46例（71.9%）患者可出院。非居家出院的危险因素为更高的mFI-11 (p = 0.027)，手术相关的运动功能障碍(p)。结论：在新诊断的运动功能障碍胶质母细胞瘤患者中，基于ntms的计划有助于预测术后手术相关的运动功能障碍。在制定决策时，除了基于nTMS和肌腱束造影的计划外，还需要尊重患者的虚弱，以避免术后运动缺陷，并将总体手术发病率保持在较低水平。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuro-Oncology 医学-临床神经学

CiteScore

6.60

自引率

7.70%

发文量

277

审稿时长

3.3 months

期刊介绍： The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.