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

Antonino Raco, Alessandro Pesce, Flavia Fraschetti, Giancarlo D'Andrea, Filippo Maria Polli, Michele Acqui, Alessandro Frati

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)453-463
Number of pages11
JournalJournal of Neurological Surgery, Part A: Central European Neurosurgery
Volume79
Issue number6
DOIs
Publication statusPublished - Nov 2018

Keywords

  • Adult
  • Aged
  • Brain Neoplasms/diagnostic imaging
  • Efferent Pathways/diagnostic imaging
  • Female
  • Glioma/diagnostic imaging
  • Humans
  • Karnofsky Performance Status
  • Logistic Models
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neurosurgical Procedures/adverse effects
  • Postoperative Complications/diagnostic imaging
  • Postoperative Period
  • Quality of Life
  • Retrospective Studies
  • Treatment Outcome

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