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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2025; 44(01): e8-e14
DOI: 10.1055/s-0045-1801859
Original Article

The Impact of Surgery on Butterfly Gliomas – A Real-life Study of Biopsy versus Surgical Resection

O impacto da cirurgia em gliomas de borboleta – Um estudo real de biópsia versus ressecção cirúrgica
Helder Picarelli 
1   Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
2   Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (ICESP), São Paulo, SP, Brazil
,
Vitor Macedo Brito Medeiros 
1   Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
,
Pedro Henrique Fonseca de Castro 
1   Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
,
Guilherme Bezerra Carneiro
1   Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
,
Bruno Massanori Matsumura
1   Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
,
Augusto Magno Tranquezi Cordeiro 
1   Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
,
Vitor Nagai Yamaki 
1   Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
,
Eberval Gadelha Figueiredo 
1   Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
,
Manoel Jacobsen Teixeira 
1   Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
› Author Affiliations Funding The authors declare that they did not receive funding from agencies in the public, private or non-profit sectors to conduct the present study.
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Abstract

Introduction Although the extent of resection affects the overall survival of patients with gliomas, cytoreduction in patients with butterfly gliomas (BGs) remains controversial. Contemporary studies suggest that wide removal is feasible, but there is a lack of controlled, randomized, multicenter studies on the subject. The aim of the present study was to evaluate the impact of maximal safe resection (MSR) as a primary treatment strategy in patients with BG.

Methods A total of 30 consecutive patients, primarily treated with neurosurgery, were categorized into group A, in whom MSR was ≥ 50%, and group B, in whom MSR was < 50% (biopsy). The groups were studied and compared in terms of clinical and epidemiological characteristics, functionality, survival time (ST), and progression-free survival (PFS).

Results The results were analyzed through descriptive and inferential statistics. The most frequent tumor was IDH1-wild type glioblastoma, Grade 4 according to the World Health Organization (WHO) classification. Most patients (80%) had Karnofsky Performance Status (KPS) < 70%; however, there was no significant worsening in functionality associated with the interventions. Wider resections, i.e., those performed in group A, were associated with better Kaplan-Meier curves and ST compared with group B (68.35 versus 17.32 weeks respectively; p = 0.014). The PFS was also longer in group A compared to group B (57.70 versus 4.77 weeks, respectively; p = 0.012). In the multivariate analysis, resections > 50% were associated with reduced risk of recurrence (hazard ratio [HR] = 0.20; 95% confidence interval [95%CI] = 0.06–0.67; p = 0.009). The complication rates and functional decline were similar between groups.

Conclusion Surgical resections > 50% in patients with BG improved ST and PFS without a significant increase in morbidity or dysfunction.

Resumo

Introdução Embora a extensão da ressecção afetar a sobrevida geral dos pacientes com gliomas, a citorredução em pacientes com gliomas em asa de borboleta (GABs) permanece controversa. Apesar de estudos contemporâneos sugerirem que a remoção ampla é viável neste contexto, ainda faltam estudos controlados, randomizados e multicêntricos sobre o assunto. O objetivo deste estudo foi avaliar o impacto da máxima ressecção segura (MRS) como uma estratégia de tratamento primário em pacientes com GAB.

Métodos Ao todo, 30 pacientes consecutivos, tratados primariamente com neurocirurgia, foram categorizados como o grupo A, no qual a MRS foi ≥ 50%, e no grupo B, no qual a MRS foi < 50% (biópsia). Os grupos foram estudados e comparados quanto às características clínicas, epidemiológicas, funcionalidade, tempo de sobrevida (TS) e sobrevida livre de progressão (SLP).

Resultados Os resultados foram analisados por meio de técnicas de estatística descritiva e inferencial. O tumor mais frequente foi glioblastoma de tipo selvagem do gene IDH1, de grau 4 na classificação da Organização Mundial da Saúde (OMS). A maioria dos pacientes (80%) tinha Karnofsky Performance Status (KPS) < 70%, mas não houve piora significativa da funcionalidade associada às intervenções. Ressecções mais amplas, ou seja, as realizadas no grupo A, foram associadas a curvas de Kaplan-Meier e TS melhores em comparação com o grupo B (68,35 semanas versus 17,32 semanas, respectivamente; p = 0,014). A SLP também foi mais longa neste grupo em comparação com o grupo B (57,70 semanas versus 4,77 semanas, respectivamente; p = 0,012). Na análise multivariada, ressecções > 50% foram associadas a um risco reduzido de recorrência (razão de risco [RR] = 0,20; intervalo de confiança de 95% [IC95%] = 0,06–0,67; p = 0,009). As taxas de complicações e o declínio funcional foram semelhantes entre os grupos.

Conclusão Em pacientes com GAB, as ressecções cirúrgicas (> 50%) melhoraram o TS e a SLP, sem aumento significativo na morbidade e nas disfunções.

Keywords

butterfly glioma - biopsy - surgical resection - survival - progression-free survival

Palavras-chave

gliomas em asa de borboleta - biopsia - ressecção cirúrgica - sobrevida - sobrevida livre de progressão


Publication History

Received: 18 June 2024

Accepted: 21 October 2024

Article published online:
27 March 2025

© 2025. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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