Predictors of Permanent and Temporary Motor Deficits in Patients Undergoing Glioma Resection: A Systematic Review and Meta-Analysis.

Abstract

To identify predictors of permanent and temporary motor deficits in patients undergoing glioma resection. A literature search accessed the databases Ovid Medline, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature/EBSCO, PsychInfo, Cochrane, and Wiley for studies reporting motor outcomes following surgical resection of glioma. Outcomes were stratified by patient/tumor characteristics, preoperative condition, and intraoperative factors for both permanent and temporary motor deficits. Generalized estimating equations were used to generate odds ratios. A total of 1332 titles and abstracts were reviewed resulting in the evaluation of 261 full-text articles. Data were extracted from 67 studies including 2616 patients with 371 (14%) developing permanent postoperative motor deficits, 465 (18%) developing temporary deficits, and the remaining 1780 (68%) having no deficit. Preoperative deficit was the most significant predictor of permanent postoperative motor deficit (odds ratio [OR] 6.40, confidence interval [CI] 2.82-14.5, P < 0.0001), while high preoperative Karnofsky Performance Scale (OR 0.98, CI 0.97-0.99, P < 0.001) and subcortical tumor location (OR 0.14, C 0.030-0.62, P = 0.001) had a lower odds of a permanent deficit. Intraoperative motor-evoked potential changes was a significant predictor of both permanent (OR 5.18, CI 1.99-13.5, P = 0.00075) and temporary (OR 9.44, CI 2.78-32.0, P = 0.0003) motor deficits. Preoperative motor deficits were the most significant predictors of persistent or worsening postoperative motor deficits. Intraoperative motor-evoked potential changes were associated with both permanent and temporary deficits. High Karnofsky Performance Scale and subcortical tumor location had lower odds of permanent motor deficits.