Thomas Eibl, Adrian Liebert, Leonard Ritter, Markus Neher, Karl-Michael Schebesch
{"title":"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。","authors":"Thomas Eibl, Adrian Liebert, Leonard Ritter, Markus Neher, Karl-Michael Schebesch","doi":"10.1007/s11060-025-05206-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"1367-1375"},"PeriodicalIF":3.1000,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Role of patient frailty in resection of newly diagnosed motor eloquent glioblastomas guided by a navigated transcranial magnetic stimulation and tractography approach.\",\"authors\":\"Thomas Eibl, Adrian Liebert, Leonard Ritter, Markus Neher, Karl-Michael Schebesch\",\"doi\":\"10.1007/s11060-025-05206-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":16425,\"journal\":{\"name\":\"Journal of Neuro-Oncology\",\"volume\":\" \",\"pages\":\"1367-1375\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2025-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Neuro-Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11060-025-05206-7\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/9 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuro-Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11060-025-05206-7","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/9 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Role of patient frailty in resection of newly diagnosed motor eloquent glioblastomas guided by a navigated transcranial magnetic stimulation and tractography approach.
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.
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.
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