• Domenique M J Müller, Pierre A Robe, Hilko Ardon, Frederik Barkhof, Lorenzo Bello, Mitchel S Berger, Wim Bouwknegt, Wimar A Van den Brink, Conti NibaliMarcoM6Neurosurgical Oncology Unit, Departments of Oncology and Remato-Oncology, Università degli Studi di Milano, Humanitas Research Hospital, IRCCS, Milan, Italy., Roelant S Eijgelaar, Julia Furtner, Seunggu J Han, Shawn L Hervey-Jumper, IdemaAlbert J SAJS13Department of Neurosurgery, Northwest Clinics, Alkmaar, The Netherlands., Barbara Kiesel, Alfred Kloet, Jan C De Munck, Marco Rossi, Tommaso Sciortino, W Peter Vandertop, Martin Visser, Michiel Wagemakers, Georg Widhalm, Marnix G Witte, Aeilko H Zwinderman, and Philip C De Witt Hamer.
• 1Brain Tumor Center & Department of Neurosurgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.
• J. Neurosurg. 2021 Mar 1; 134 (3): 109111011091-1101.

ObjectiveDecisions in glioblastoma surgery are often guided by presumed eloquence of the tumor location. The authors introduce the "expected residual tumor volume" (eRV) and the "expected resectability index" (eRI) based on previous decisions aggregated in resection probability maps. The diagnostic accuracy of eRV and eRI to predict biopsy decisions, resectability, functional outcome, and survival was determined.MethodsConsecutive patients with first-time glioblastoma surgery in 2012-2013 were included from 12 hospitals. The eRV was calculated from the preoperative MR images of each patient using a resection probability map, and the eRI was derived from the tumor volume. As reference, Sawaya's tumor location eloquence grades (EGs) were classified. Resectability was measured as observed extent of resection (EOR) and residual volume, and functional outcome as change in Karnofsky Performance Scale score. Receiver operating characteristic curves and multivariable logistic regression were applied.ResultsOf 915 patients, 674 (74%) underwent a resection with a median EOR of 97%, functional improvement in 71 (8%), functional decline in 78 (9%), and median survival of 12.8 months. The eRI and eRV identified biopsies and EORs of at least 80%, 90%, or 98% better than EG. The eRV and eRI predicted observed residual volumes under 10, 5, and 1 ml better than EG. The eRV, eRI, and EG had low diagnostic accuracy for functional outcome changes. Higher eRV and lower eRI were strongly associated with shorter survival, independent of known prognostic factors.ConclusionsThe eRV and eRI predict biopsy decisions, resectability, and survival better than eloquence grading and may be useful preoperative indices to support surgical decisions.

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