• Jun Muto, Edouard Dezamis, Odile Rigaux-Viode, Sophie Peeters, Alexandre Roux, Marc Zanello, Charles Mellerio, Xavier Sauvageon, Pascale Varlet, Catherine Oppenheim, and Johan Pallud.
• Department of Neurosurgery, Sainte-Anne Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; Department of Neurosurgery, Keio University School of Medicine, Minato, Tokyo, Japan.
• World Neurosurg. 2018 May 1; 113: e200-e212.

ObjectiveWe assessed the impact of surgery on postoperative cognitive function and ability to work in adult patients with a diffuse low-grade glioma involving eloquent brain regions and having a functional-based maximal surgical resection using intraoperative corticosubcortical mapping under awake conditions.MethodsWe prospectively included 39 consecutive patients with diffuse isocitrate dehydrogenase-mutant low-grade glioma without preoperative and adjuvant oncologic treatment and assessed preoperative (mean, 24.1 ± 21.2 days before surgery) and postoperative (mean, 14.6 ± 13.2 months after surgery) cognitive evaluations and ability to work together with clinical, imaging, therapeutic, and follow-up characteristics before tumor progression.ResultsNone of the 3 patients without preoperative cognitive deficit had postoperative worsening. We observed a significant inverse interaction between worsened postoperative cognitive function and extent of resection: 80.0%, 18.8%, and 16.7% of worsening after partial, subtotal, and total resection, respectively (P = 0.020). We observed an independent interaction between improved postoperative cognitive function and extent of resection: 20.0%, 43.7%, and 44.4% of improvement after partial, subtotal, and total resection, respectively (P = 0.022). Of the employed patients, 61.8% were unable to work preoperatively and 82.4% resumed their employment postoperatively (mean, 6.9 ± 5.5 months). We observed an independent interaction between postoperative ability to work, similar or superior to preoperative work capacity and extent of resection (P < 0.001): 20.0%, 87.5%, and 100% ability to work after partial, subtotal resection, and total resection.ConclusionsThe extent of the functional-based surgical resection and the residual tumor for diffuse low-grade gliomas involving eloquent brain regions correlate with postoperative cognitive outcomes and return to work rates.Copyright © 2018 Elsevier Inc. All rights reserved.

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