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Pichardo-Rojas PS, Angulo-Lozano JC, Alvarez-Castro JA, Vázquez-Alva D, Osuna-Lau RA, Choque-Ayala LC, Tandon N, Esquenazi Y. Intraoperative Magnetic Resonance Imaging (MRI)-Guided Resection of Glioblastoma: A Meta-Analysis of 1,847 Patients. World Neurosurg 2024; 182:e807-e822. [PMID: 38101537 DOI: 10.1016/j.wneu.2023.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Pavel S Pichardo-Rojas
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA.
| | - Juan Carlos Angulo-Lozano
- Laboratory of Molecular Genetics and Immunology, The Rockefeller University, New York, New York, USA
| | - José Alfonso Alvarez-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, Mexico
| | - Diego Vázquez-Alva
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | | | - Luz Camila Choque-Ayala
- Facultad de Medicina, Universidad Católica Boliviana San Pablo, Santa Cruz de la Sierra, Bolivia
| | - Nitin Tandon
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
| | - Yoshua Esquenazi
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
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Zhang W, Ille S, Schwendner M, Wiestler B, Meyer B, Krieg SM. The Impact of ioMRI on Glioblastoma Resection and Clinical Outcomes in a State-of-the-Art Neuro-Oncological Setup. Cancers (Basel) 2023; 15:3563. [PMID: 37509226 PMCID: PMC10377519 DOI: 10.3390/cancers15143563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Intraoperative magnetic resonance imaging (ioMRI) aims to improve gross total resection (GTR) in glioblastoma (GBM) patients. Despite some older randomized data on safety and feasibility, ioMRI's actual impact in a modern neurosurgical setting utilizing a larger armamentarium of techniques has not been sufficiently investigated to date. We therefore aimed to analyze its effects on residual tumor, patient outcome, and progression-free survival (PFS) in GBM patients in a modern high-volume center. Patients undergoing ioMRI for resection of supratentorial GBM were enrolled between March 2018 and June 2020. ioMRI was performed in all cases at the end of resection when surgeons expected complete macroscopic tumor removal. Extent of resection (EOR) was performed by volumetric analysis, with GTR defined as an EOR ≥ 95%, respectively. Progression-free survival (PFS) was analyzed through univariate and multivariate Cox proportional regression analyses. In total, we enrolled 172 patients. Mean EOR increased from 93.9% to 98.3% (p < 0.0001) due to ioMRI, equaling an increase in GTR rates from 78.5% to 93.0% (p = 0.0002). Residual tumor volume decreased from 1.3 ± 4.2 cm3 to 0.6 ± 2.5 cm3 (p = 0.0037). Logistic regression revealed recurrent GBM as a risk factor leading to subtotal resection (STR) (odds ratio (OR) = 3.047, 95% confidence interval (CI) 1.165-7.974, p = 0.023). Additional resection after ioMRI led to equally long PFS compared to patients with complete tumor removal before ioMRI (hazard ratio (HR) = 0.898, 95%-CI 0.543-1.483, p = 0.67). ioMRI considerably reduces residual tumor volume and helps to achieve comparable PFS, even in patients with unexpected residual tumor after initial resection before ioMRI.
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Affiliation(s)
- Wei Zhang
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Maximilian Schwendner
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
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Bonosi L, Marrone S, Benigno UE, Buscemi F, Musso S, Porzio M, Silven MP, Torregrossa F, Grasso G. Maximal Safe Resection in Glioblastoma Surgery: A Systematic Review of Advanced Intraoperative Image-Guided Techniques. Brain Sci 2023; 13:brainsci13020216. [PMID: 36831759 PMCID: PMC9954589 DOI: 10.3390/brainsci13020216] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/15/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Glioblastoma multiforme (GBM) represents the most common and aggressive central nervous system tumor associated with a poor prognosis. The aim of this study was to depict the role of intraoperative imaging techniques in GBM surgery and how they can ensure the maximal extent of resection (EOR) while preserving the functional outcome. The authors conducted a systematic review following PRISMA guidelines on the PubMed/Medline and Scopus databases. A total of 1747 articles were identified for screening. Studies focusing on GBM-affected patients, and evaluations of EOR and functional outcomes with the aid of advanced image-guided techniques were included. The resulting studies were assessed for methodological quality using the Risk of Bias in Systematic Review tool. Open Science Framework registration DOI 10.17605/OSF.IO/3FDP9. Eighteen studies were eligible for this systematic review. Among the selected studies, eight analyzed Sodium Fluorescein, three analyzed 5-aminolevulinic acid, two evaluated IoMRI imaging, two evaluated IoUS, and three evaluated multiple intraoperative imaging techniques. A total of 1312 patients were assessed. Gross Total Resection was achieved in the 78.6% of the cases. Follow-up time ranged from 1 to 52 months. All studies assessed the functional outcome based on the Karnofsky Performance Status scale, while one used the Neurologic Assessment in Neuro-Oncology score. In 77.7% of the cases, the functional outcome improved or was stable over the pre-operative assessment. Combining multiple intraoperative imaging techniques could provide better results in GBM surgery than a single technique. However, despite good surgical outcomes, patients often present a neurocognitive decline leading to a marked deterioration of the quality of life. Advanced intraoperative image-guided techniques can allow a better understanding of the anatomo-functional relationships between the tumor and the surrounding brain, thus maximizing the EOR while preserving functional outcomes.
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Liu D, Dai X, Ye L, Wang H, Qian H, Cheng H, Wang X. Nanotechnology meets glioblastoma multiforme: Emerging therapeutic strategies. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2023; 15:e1838. [PMID: 35959642 DOI: 10.1002/wnan.1838] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 01/31/2023]
Abstract
Glioblastoma multiforme (GBM) represents the most common and fatal form of primary invasive brain tumors as it affects a great number of patients each year and has a median overall survival of approximately 14.6 months after diagnosis. Despite intensive treatment, almost all patients with GBM experience recurrence, and their 5-year survival rate is approximately 5%. At present, the main clinical treatment strategy includes surgical resection, radiotherapy, and chemotherapy. However, tumor heterogeneity, blood-brain barrier, glioma stem cells, and DNA damage repair mechanisms hinder efficient GBM treatment. The emergence of nanometer-scale diagnostic and therapeutic approaches in cancer medicine due to the establishment of nanotechnology provides novel and promising tools that will allow us to overcome these difficulties. This review summarizes the application and recent progress in nanotechnology-based monotherapies (e.g., chemotherapy) and combination cancer treatment strategies (chemotherapy-based combined cancer therapy) for GBM and describes the synergistic enhancement between these combination therapies as well as the current standard therapy for brain cancer and its deficiencies. These combination therapies that can reduce individual drug-related toxicities and significantly enhance therapeutic efficiency have recently undergone rapid development. The mechanisms underlying these different nanotechnology-based therapies as well as the application of nanotechnology in GBM (e.g., in photodynamic therapy and chemodynamic therapy) have been systematically summarized here in an attempt to review recent developments and to identify promising directions for future research. This review provides novel and clinically significant insights and directions for the treatment of GBM, which is of great clinical importance. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease Diagnostic Tools > In Vivo Nanodiagnostics and Imaging.
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Affiliation(s)
- Dongdong Liu
- School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Medical University, Hefei, China.,Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xingliang Dai
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lei Ye
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hua Wang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Haisheng Qian
- School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Medical University, Hefei, China
| | - Hongwei Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xianwen Wang
- School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Medical University, Hefei, China
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Gamboa NT, Crabb B, Henson JC, Cole KL, Weaver BD, Karsy M, Jensen RL. High-grade glioma imaging volumes and survival: a single-institution analysis of 101 patients after resection using intraoperative MRI. J Neurooncol 2022; 160:555-565. [DOI: 10.1007/s11060-022-04159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/05/2022] [Indexed: 11/19/2022]
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6
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Guo QL, Dai XL, Yin MY, Cheng HW, Qian HS, Wang H, Zhu DM, Wang XW. Nanosensitizers for sonodynamic therapy for glioblastoma multiforme: current progress and future perspectives. Mil Med Res 2022; 9:26. [PMID: 35676737 PMCID: PMC9178901 DOI: 10.1186/s40779-022-00386-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/22/2022] [Indexed: 02/07/2023] Open
Abstract
Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor, and it is associated with poor prognosis. Its characteristics of being highly invasive and undergoing heterogeneous genetic mutation, as well as the presence of the blood-brain barrier (BBB), have reduced the efficacy of GBM treatment. The emergence of a novel therapeutic method, namely, sonodynamic therapy (SDT), provides a promising strategy for eradicating tumors via activated sonosensitizers coupled with low-intensity ultrasound. SDT can provide tumor killing effects for deep-seated tumors, such as brain tumors. However, conventional sonosensitizers cannot effectively reach the tumor region and kill additional tumor cells, especially brain tumor cells. Efforts should be made to develop a method to help therapeutic agents pass through the BBB and accumulate in brain tumors. With the development of novel multifunctional nanosensitizers and newly emerging combination strategies, the killing ability and selectivity of SDT have greatly improved and are accompanied with fewer side effects. In this review, we systematically summarize the findings of previous studies on SDT for GBM, with a focus on recent developments and promising directions for future research.
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Affiliation(s)
- Qing-Long Guo
- School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Medical University, Hefei, 230032, China.,Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
| | - Xing-Liang Dai
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
| | - Meng-Yuan Yin
- School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Medical University, Hefei, 230032, China.,Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
| | - Hong-Wei Cheng
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China.
| | - Hai-Sheng Qian
- School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Medical University, Hefei, 230032, China
| | - Hua Wang
- Department of Oncology, the First Affiliated Hospital of Anhui Medical University, Hefei, 230032, China
| | - Dao-Ming Zhu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, the First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
| | - Xian-Wen Wang
- School of Biomedical Engineering, Research and Engineering Center of Biomedical Materials, Anhui Medical University, Hefei, 230032, China.
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Gray K, Avitsian R, Kakumanu S, Venkatraghavan L, Chowdhury T. The Effects of Anesthetics on Glioma Progression: A Narrative Review. J Neurosurg Anesthesiol 2022; 34:168-175. [PMID: 32658099 DOI: 10.1097/ana.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/15/2020] [Indexed: 11/26/2022]
Abstract
There are many established factors that influence glioma progression, including patient age, grade of tumor, genetic mutations, extent of surgical resection, and chemoradiotherapy. Although the exposure time to anesthetics during glioma resection surgery is relatively brief, the hemodynamic changes involved and medications used, as well as the stress response throughout the perioperative period, may also influence postoperative outcomes in glioma patients. There are numerous studies that have demonstrated that choice of anesthesia influences non-brain cancer outcomes; of particular interest are those describing that the use of total intravenous anesthesia may yield superior outcomes compared with volatile agents in in vitro and human studies. Much remains to be discovered on the topic of anesthesia's effect on glioma progression.
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Affiliation(s)
| | - Rafi Avitsian
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Saranya Kakumanu
- Department of Radiation Oncology, Cancer Care Manitoba, Winnipeg, MB
| | - Lashmi Venkatraghavan
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada
| | - Tumul Chowdhury
- Department of Anesthesiology, Perioperative, and Pain Medicine, Health Sciences Center, University of Manitoba
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Naik A, Smith EJ, Barreau A, Nyaeme M, Cramer SW, Najafali D, Krist DT, Arnold PM, Hassaneen W. Comparison of fluorescein sodium, 5-ALA, and intraoperative MRI for resection of high-grade gliomas: A systematic review and network meta-analysis. J Clin Neurosci 2022; 98:240-247. [PMID: 35219089 DOI: 10.1016/j.jocn.2022.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/08/2022] [Accepted: 02/17/2022] [Indexed: 12/31/2022]
Abstract
High grade gliomas (HGGs) are aggressive brain tumors associated with poor prognosis despite advances in surgical treatment and therapy. Navigated tumor resection has yielded improved outcomes for patients. We compare 5-ALA, fluorescein sodium (FS), and intraoperative MRI (IMRI) with no image guidance to determine the best intraoperative navigation method to maximize rates of gross total resection (GTR) and outcomes. A frequentist network meta-analysis was performed following standard PRISMA guidelines (PROSPERO registration CRD42021268659). Surface-under-the-cumulative ranking (SUCRA) analysis was executed to hierarchically rank modalities by the outcomes of interest. Heterogeneity was measured by the I2 statistic. Publication bias was assessed by funnel plots and the use of Egger's test. Statistical significance was determined by p < 0.05. Twenty-three studies were included for analysis with a total of 2,643 patients. Network meta-analysis comparing 5-ALA, IMRI, and FS was performed. The primary outcome assessed was the rate of GTR. Analysis revealed the superiority of all intraoperative navigation to control (no navigation). SUCRA analysis revealed the superiority of IMRI + 5-ALA, IMRI alone, followed by FS, and 5-ALA. Overall survival (OS) and progression free survival (PFS) were also examined. FS (vs. control) was associated with improved OS, while IMRI was associated with improved PFS (vs. control, FS, and 5-ALA). Intraoperative navigation using IMRI, FS, and 5-ALA lead to greater rates of GTR in HGGs. FS and 5-ALA also yielded improvement in OS and PFS. Further studies are needed to evaluate differences in survival benefit, operative duration, and cost.
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Affiliation(s)
- Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - Emily J Smith
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - Ariana Barreau
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - Mark Nyaeme
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - Samuel W Cramer
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis MN, 55455, United States
| | - Daniel Najafali
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - David T Krist
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States
| | - Paul M Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States; Department of Neurosurgery, Carle Foundation Hospital, Urbana IL 61801, United States
| | - Wael Hassaneen
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, United States; Department of Neurosurgery, Carle Foundation Hospital, Urbana IL 61801, United States.
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9
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Cho SS, Salinas R, De Ravin E, Teng CW, Li C, Abdullah KG, Buch L, Hussain J, Ahmed F, Dorsey J, Mohan S, Brem S, Singhal S, Lee JYK. Near-Infrared Imaging with Second-Window Indocyanine Green in Newly Diagnosed High-Grade Gliomas Predicts Gadolinium Enhancement on Postoperative Magnetic Resonance Imaging. Mol Imaging Biol 2021; 22:1427-1437. [PMID: 31712948 DOI: 10.1007/s11307-019-01455-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Intraoperative molecular imaging with tumor-targeting fluorophores offers real-time detection of neoplastic tissue. The second window indocyanine green (SWIG) technique relies on passive accumulation of indocyanine green (ICG), a near-infrared fluorophore, in neoplastic tissues. In this study, we explore the ability of SWIG to detect neoplastic tissue and to predict postoperative magnetic resonance imaging (MRI) findings intraoperatively. PROCEDURES Retrospective data were collected from 36 patients with primary high-grade gliomas (HGG) enrolled as part of a larger trial between October 2014 and October 2018. Patients received systemic ICG infusions at 2.5-5 mg/kg 24 h preoperatively. Near-infrared fluorescence was recorded throughout the case and from biopsy specimens. The presence/location of residual SWIG signal after resection was compared to the presence/location of residual gadolinium enhancement on postoperative MRI. The extent of resection was not changed based on near-infrared imaging. RESULTS All 36 lesions demonstrated strong near-infrared fluorescence (signal-to-background = 6.8 ± 2.2) and 100 % of tumors reaching the cortex were visualized before durotomy. In 78 biopsy specimens, near-infrared imaging demonstrated higher sensitivity and accuracy than white light for diagnosing neoplastic tissue intraoperatively. Furthermore, near-infrared imaging predicted gadolinium enhancement on postoperative MRI with 91 % accuracy, with visualization of residual enhancement as small as 0.3 cm3. Patients with no residual near-infrared signal after resection were significantly more likely to have complete resection on postoperative MRI (p value < 0.0001). CONCLUSIONS Intraoperative imaging with SWIG demonstrates highly sensitive detection of HGG tissue in real time. Furthermore, post-resection near-infrared imaging correlates with postoperative MRI. Overall, our findings suggest that SWIG can provide surgeons with MRI-like results in real time, potentially increasing resection rates.
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Affiliation(s)
- Steve S Cho
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Salinas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Emma De Ravin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Clare W Teng
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie Li
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kalil G Abdullah
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Love Buch
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jasmin Hussain
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Fahad Ahmed
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jay Dorsey
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Suyash Mohan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Brem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sunil Singhal
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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Gosal JS, Tiwari S, Sharma T, Agrawal M, Garg M, Mahal S, Bhaskar S, Sharma RK, Janu V, Jha DK. Simulation of surgery for supratentorial gliomas in virtual reality using a 3D volume rendering technique: a poor man's neuronavigation. Neurosurg Focus 2021; 51:E23. [PMID: 34333461 DOI: 10.3171/2021.5.focus21236] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Different techniques of performing image-guided neurosurgery exist, namely, neuronavigation systems, intraoperative ultrasound, and intraoperative MRI, each with its limitations. Except for ultrasound, other methods are expensive. Three-dimensional virtual reconstruction and surgical simulation using 3D volume rendering (VR) is an economical and excellent technique for preoperative surgical planning and image-guided neurosurgery. In this article, the authors discuss several nuances of the 3D VR technique that have not yet been described. METHODS The authors included 6 patients with supratentorial gliomas who underwent surgery between January 2019 and March 2021. Preoperative clinical data, including patient demographics, preoperative planning details (done using the VR technique), and intraoperative details, including relevant photos and videos, were collected. RadiAnt software was used for generating virtual 3D images using the VR technique on a computer running Microsoft Windows. RESULTS The 3D VR technique assists in glioma surgery with a preoperative simulation of the skin incision and craniotomy, virtual cortical surface marking and navigation for deep-seated gliomas, preoperative visualization of morbid cortical surface and venous anatomy in surfacing gliomas, identifying the intervenous surgical corridor in both surfacing and deep-seated gliomas, and pre- and postoperative virtual 3D images highlighting the exact spatial geometric residual tumor location and extent of resection for low-grade gliomas (LGGs). CONCLUSIONS Image-guided neurosurgery with the 3D VR technique using RadiAnt software is an economical, easy-to-learn, and user-friendly method of simulating glioma surgery, especially in resource-constrained countries where expensive neuronavigation systems are not readily available. Apart from cortical sulci/gyri anatomy, FLAIR sequences are ideal for the 3D visualization of nonenhancing diffuse LGGs using the VR technique. In addition to cortical vessels (especially veins), contrast MRI sequences are perfect for the 3D visualization of contrast-enhancing high-grade gliomas.
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Affiliation(s)
| | - Sarbesh Tiwari
- 2Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | | | | | | | - Sayani Mahal
- 2Diagnostic & Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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Rogers CM, Jones PS, Weinberg JS. Intraoperative MRI for Brain Tumors. J Neurooncol 2021; 151:479-490. [PMID: 33611714 DOI: 10.1007/s11060-020-03667-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The use of intraoperative imaging has been a critical tool in the neurosurgeon's armamentarium and is of particular benefit during tumor surgery. This article summarizes the history of its development, implementation, clinical experience and future directions. METHODS We reviewed the literature focusing on the development and clinical experience with intraoperative MRI. Utilizing the authors' personal experience as well as evidence from the literature, we present an overview of the utility of MRI during neurosurgery. RESULTS In the 1990s, the first description of using a low field MRI in the operating room was published describing the additional benefit provided by improved resolution of MRI as compared to ultrasound. Since then, implementation has varied in magnetic field strength and in configuration from floor mounted to ceiling mounted units as well as those that are accessible to the operating room for use during surgery and via an outpatient entrance to use for diagnostic imaging. The experience shows utility of this technique for increasing extent of resection for low and high grade tumors as well as preventing injury to important structures while incorporating techniques such as intraoperative monitoring. CONCLUSION This article reviews the history of intraoperative MRI and presents a review of the literature revealing the successful implementation of this technology and benefits noted for the patient and the surgeon.
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Affiliation(s)
- Cara Marie Rogers
- Department of Neurosurgery, Virginia Tech Carilion, Roanoke, VA, USA
| | - Pamela S Jones
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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12
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Laochamroonvorapongse D, Theard MA, Yahanda AT, Chicoine MR. Intraoperative MRI for Adult and Pediatric Neurosurgery. Anesthesiol Clin 2021; 39:211-225. [PMID: 33563383 DOI: 10.1016/j.anclin.2020.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Intraoperative MRI (iMRI) technology and its use in both adult and pediatric neurosurgery have advanced significantly over the past 2 decades, allowing neurosurgeons to account for brain shift and optimize resection of brain lesions. Combining the risks of the MR environment with those of the operating room creates a challenging, zero-tolerance environment for the anesthesiologist. This article provides an overview of the currently available iMRI systems, the neurosurgical evidence supporting iMRI use, and the anesthetic and safety considerations for iMRI procedures.
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Affiliation(s)
- Dean Laochamroonvorapongse
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code-UH2, Portland, OR 97239, USA.
| | - Marie A Theard
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code-UH2, Portland, OR 97239, USA
| | - Alexander T Yahanda
- Department of Neurosurgery, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Michael R Chicoine
- Department of Neurosurgery, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
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Lo YT, Lee H, Shui C, Lamba N, Korde R, Devi S, Chawla S, Nam Y, Patel R, Doucette J, Bunevicius A, Mekary RA. Intraoperative Magnetic Resonance Imaging for Low-Grade and High-Grade Gliomas: What Is the Evidence? A Meta-Analysis. World Neurosurg 2021; 149:232-243.e3. [PMID: 33540099 DOI: 10.1016/j.wneu.2021.01.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The benefit of intraoperative magnetic resonance imaging (iMRI) in gliomas remains unclear. We performed a meta-analysis of outcomes with iMRI-guided surgery in high-grade gliomas (HGGs) and low-grade gliomas (LGGs). METHODS Databases were searched until November 29, 2018 for randomized controlled trials (RCTs) and observational studies (OBS) comparing iMRI use with conventional neurosurgery. Pooled risk ratios (RRs) or hazard ratios were evaluated with the random-effects model. Outcomes included extent of resection (EOR), gross total resection (GTR), progression-free survival (PFS), overall survival (OS), and length of surgery (LOS), stratified by study design and glioma grade. RESULTS Fifteen articles (3 RCTs and 12 OBS) were included. In RCTs, GTR was higher in iMRI compared with conventional neurosurgery (RR, 1.42; 95% confidence interval [CI], 1.17-1.73; I2, 7%) overall, for LGGs (1.91; 95% CI, 1.19-3.06), but not HGGs (1.24; 95% CI, 0.89-1.73), with no difference in EOR, PFS, OS, and LOS. For OBS, GTR was higher (RR, 1.65; 95% CI, 1.43-1.90; I2, 4%) overall, and for LGGs (1.63; 95% CI, 1.17-2.28; I2, 0%) and HGGs (1.62; 95% CI, 1.36-1.92; I2, 19%). EOR was greater with iMRI (6%; 95% CI, 4%-8%; I2, 44%) overall, in LGGs (5%; 95% CI, 2%-8%; I2, 37%) and HGGs (7%; 95% CI, 4%-10%; I2, 13%). There was no difference in PFS, OS, and LOS with iMRI. CONCLUSIONS IMRI use improved GTR in gliomas, including LGGs. However, no PFS and OS benefit was shown in the meta-analysis.
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Affiliation(s)
- Yu Tung Lo
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Hyunkyung Lee
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Cher Shui
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nayan Lamba
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rasika Korde
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Sharmila Devi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Shreya Chawla
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Younjong Nam
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Romel Patel
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Joanne Doucette
- School of Pharmacy, MCPHS University, Boston, Massachusetts, USA
| | - Adomas Bunevicius
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Neuroscience Institute, Lithuanian University of Health Science, Kaunas, Lithuania; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; School of Pharmacy, MCPHS University, Boston, Massachusetts, USA.
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Shah AS, Yahanda AT, Sylvester PT, Evans J, Dunn GP, Jensen RL, Honeycutt J, Cahill DP, Sutherland GR, Oswood M, Shah M, Abram SR, Rich KM, Dowling JL, Leuthardt EC, Dacey RG, Kim AH, Zipfel GJ, Limbrick DD, Smyth MD, Leonard J, Chicoine MR. Using Histopathology to Assess the Reliability of Intraoperative Magnetic Resonance Imaging in Guiding Additional Brain Tumor Resection: A Multicenter Study. Neurosurgery 2020; 88:E49-E59. [PMID: 32803226 DOI: 10.1093/neuros/nyaa338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 05/24/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Intraoperative magnetic resonance imaging (iMRI) is a powerful tool for guiding brain tumor resections, provided that it accurately discerns residual tumor. OBJECTIVE To use histopathology to assess how reliably iMRI may discern additional tumor for a variety of tumor types, independent of the indications for iMRI. METHODS A multicenter database was used to calculate the odds of additional resection during the same surgical session for grade I to IV gliomas and pituitary adenomas. The reliability of iMRI for identifying residual tumor was assessed using histopathology of tissue resected after iMRI. RESULTS Gliomas (904/1517 cases, 59.6%) were more likely than pituitary adenomas (176/515, 34.2%) to receive additional resection after iMRI (P < .001), but these tumors were equally likely to have additional tissue sent for histopathology (398/904, 44.4% vs 66/176, 37.5%; P = .11). Tissue samples were available for resections after iMRI for 464 cases, with 415 (89.4%) positive for tumor. Additional resections after iMRI for gliomas (361/398, 90.7%) were more likely to yield additional tumor compared to pituitary adenomas (54/66, 81.8%) (P = .03). There were no significant differences in resection after iMRI yielding histopathologically positive tumor between grade I (58/65 cases, 89.2%; referent), grade II (82/92, 89.1%) (P = .98), grade III (72/81, 88.9%) (P = .95), or grade IV gliomas (149/160, 93.1%) (P = .33). Additional resection for previously resected tumors (122/135 cases, 90.4%) was equally likely to yield histopathologically confirmed tumor compared to newly-diagnosed tumors (293/329, 89.0%) (P = .83). CONCLUSION Histopathological analysis of tissue resected after use of iMRI for grade I to IV gliomas and pituitary adenomas demonstrates that iMRI is highly reliable for identifying residual tumor.
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Affiliation(s)
- Amar S Shah
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - John Evans
- Washington University School of Medicine, St. Louis, Missouri
| | - Gavin P Dunn
- Washington University School of Medicine, St. Louis, Missouri
| | - Randy L Jensen
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | | | | | - Mark Oswood
- University of Minnesota, Minneapolis, Minnesota.,Allina Health, Minneapolis, Minnesota
| | - Mitesh Shah
- Goodman Campbell and Indiana University, Indianapolis, Indiana
| | | | - Keith M Rich
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Ralph G Dacey
- Washington University School of Medicine, St. Louis, Missouri
| | - Albert H Kim
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Matthew D Smyth
- Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey Leonard
- Department of Neurosurgery, Nationwide Children's Hospital, Columbus, Ohio
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Abstract
This article discusses intraoperative imaging techniques used during high-grade glioma surgery. Gliomas can be difficult to differentiate from surrounding tissue during surgery. Intraoperative imaging helps to alleviate problems encountered during glioma surgery, such as brain shift and residual tumor. There are a variety of modalities available all of which aim to give the surgeon more information, address brain shift, identify residual tumor, and increase the extent of surgical resection. The article starts with a brief introduction followed by a review of with the latest advances in intraoperative ultrasound, intraoperative MRI, and intraoperative computed tomography.
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Affiliation(s)
- Thomas Noh
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Hawaii Pacific Health, John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Martina Mustroph
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA.
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16
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Yahanda AT, Patel B, Shah AS, Cahill DP, Sutherland G, Honeycutt J, Jensen RL, Rich KM, Dowling JL, Limbrick DD, Dacey RG, Kim AH, Leuthardt EC, Dunn GP, Zipfel GJ, Leonard JR, Smyth MD, Shah MV, Abram SR, Evans J, Chicoine MR. Impact of Intraoperative Magnetic Resonance Imaging and Other Factors on Surgical Outcomes for Newly Diagnosed Grade II Astrocytomas and Oligodendrogliomas: A Multicenter Study. Neurosurgery 2020; 88:63-73. [DOI: 10.1093/neuros/nyaa320] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/24/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative magnetic resonance imaging (iMRI) in the resection of grade II gliomas.
OBJECTIVE
To assess the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly diagnosed grade II astrocytomas and oligodendrogliomas.
METHODS
Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS and PFS.
RESULTS
A total of 232 resections (112 astrocytomas and 120 oligodendrogliomas) were analyzed. Oligodendrogliomas had longer OS (P < .001) and PFS (P = .01) than astrocytomas. Multivariate analyses demonstrated improved OS for gross total resection (GTR) vs subtotal resection (STR; P = .006, hazard ratio [HR]: .23) and near total resection (NTR; P = .02, HR: .64). GTR vs STR (P = .02, HR: .54), GTR vs NTR (P = .04, HR: .49), and iMRI use (P = .02, HR: .54) were associated with longer PFS. Frontal (P = .048, HR: 2.11) and occipital/parietal (P = .003, HR: 3.59) locations were associated with shorter PFS (vs temporal). Kaplan-Meier analyses showed longer OS with increasing extent of surgical resection (EOR) (P = .03) and 1p/19q gene deletions (P = .02). PFS improved with increasing EOR (P = .01), GTR vs NTR (P = .02), and resections above STR (P = .04). Factors influencing adjuvant treatment (35.3% of patients) included age (P = .002, odds ratio [OR]: 1.04) and EOR (P = .003, OR: .39) but not glioma subtype or location. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these instances.
CONCLUSION
EOR is a major determinant of OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.
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Affiliation(s)
- Alexander T Yahanda
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Bhuvic Patel
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Amar S Shah
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Daniel P Cahill
- Department of Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Garnette Sutherland
- Department of Neurological Surgery, University of Calgary School of Medicine, Calgary, Canada
| | - John Honeycutt
- Department of Neurological Surgery, Cook Children's Medical Center, Fort Worth, Texas
| | - Randy L Jensen
- Department of Neurological Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Keith M Rich
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Joshua L Dowling
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - David D Limbrick
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ralph G Dacey
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Albert H Kim
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Gavin P Dunn
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Gregory J Zipfel
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jeffrey R Leonard
- Department of Neurological Surgery, Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew D Smyth
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Mitesh V Shah
- Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Steven R Abram
- Department of Neurological Surgery, St. Thomas Hospital, Nashville, Tennessee
| | - John Evans
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Michael R Chicoine
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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17
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Assessment of the Extent of Resection in Surgery of High-Grade Glioma-Evaluation of Black Blood Sequences for Intraoperative Magnetic Resonance Imaging at 3 Tesla. Cancers (Basel) 2020; 12:cancers12061580. [PMID: 32549304 PMCID: PMC7352835 DOI: 10.3390/cancers12061580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 01/17/2023] Open
Abstract
Achieving an optimal extent of resection (EOR) whilst keeping lasting neurological decline to a minimum is paramount for modern neurosurgery in patients with high-grade glioma (HGG). To improve EOR assessment, this study introduces Black Blood (BB) imaging, which uses a selective saturation pulse to suppress the blood signal, to 3-Tesla intraoperative magnetic resonance imaging (iMRI). Seventy-three patients (56.4 ± 13.9 years, 64.4% male) with contrast-enhancing HGGs underwent iMRI, including contrast-enhanced (CE) and non-CE 3D turbo field-echo imaging (TFE; acquisition time: 4:20 min per sequence) and CE and non-CE 3D BB imaging (acquisition time: 1:36 min per sequence). Two readers (R1 and R2) retrospectively evaluated the EOR and diagnostic confidence (1—very inconfident to 5—very confident) as well as the delineation of tumor boarders and spread of contrast-enhancing tumor components (in case of contrast-enhancing tumor residuals). Furthermore, the contrast-to-noise ratio (CNR) was measured for contrast-enhancing tumor residuals. Both BB and conventional TFE imaging allowed for the correct detection of all contrast-enhancing tumor residuals intraoperatively (considering postsurgical MRI and histopathological evaluation as the ground truth for determination of the lack/presence of contrast-enhancing tumor residuals), but BB imaging showed significantly higher diagnostic confidence (R1: 4.65 ± 0.53 vs. 3.88 ± 1.02, p < 0.0001; R2: 4.75 ± 0.50 vs. 4.25 ± 0.81, p < 0.0001). Delineation of contrast-enhancing tumor residuals and detection of their spread into adjacent brain parenchyma was better for BB imaging. Accordingly, significantly higher CNRs were noted for BB imaging (48.1 ± 32.1 vs. 24.4 ± 15.3, p < 0.0001). In conclusion, BB imaging is not inferior to conventional TFE imaging for EOR assessment, but may significantly reduce scanning time for iMRI whilst increasing diagnostic confidence. Furthermore, given the better depiction of contrast-enhancing tumor residual spread and borders, BB imaging could support achieving complete macroscopic resection in patients suffering from HGG, which is clinically relevant as an optimal EOR is correlated to prolonged survival.
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18
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Impact of Early Reoperation on the Prognosis of Patients Operated on for Glioblastoma. World Neurosurg 2020; 139:e592-e600. [PMID: 32330620 DOI: 10.1016/j.wneu.2020.04.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The prognosis for patients with glioblastoma depends particularly on the degree of tumor resection. Patients with tumor remnants in postsurgical magnetic resonance imaging (<72 hours) may benefit from early reoperation. We present our results concerning the impact on overall survival (OS) and progression-free survival (PFS) of reoperation in patients who have already undergone surgery for glioblastoma. METHODS This study included all patients who had undergone surgery for glioblastoma with control magnetic resonance imaging, who received adjuvant therapy as per the Stupp protocol, with a minimum follow-up of 24 months. We recorded the number of complete resections, partial resections, and early reoperations. We determined the impact on OS and PFS of the early reoperations and the functional status. We considered complete resection when the volume of the residual tumor was 0 cm3. RESULTS A total of 112 patients were diagnosed with glioblastoma between March 2014 and March 2017. The study included 58 patients who fulfilled all the inclusion criteria. Complete resection was achieved in 24 patients (41.4%) and partial resection in 34 (58.6%). Of these 34 patients, 11 (32.35%) underwent early reoperation. The final result was complete resection in 58.62% of the patients. In the patients who underwent reoperation, OS and PFS were 30.3 months and 16.6 months compared with 12.7 months and 6.75 months in those without reoperation (P = 0.013 and P = 0.012). The functional prognosis was similar between the 2 groups. CONCLUSIONS Early reoperation in patients with residual tumor improved OS and PFS without increasing the number of complications compared with the patients who did not undergo reoperation.
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19
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Golub D, Hyde J, Dogra S, Nicholson J, Kirkwood KA, Gohel P, Loftus S, Schwartz TH. Intraoperative MRI versus 5-ALA in high-grade glioma resection: a network meta-analysis. J Neurosurg 2020; 134:484-498. [PMID: 32084631 DOI: 10.3171/2019.12.jns191203] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High-grade gliomas (HGGs) continue to carry poor prognoses, and patient outcomes depend heavily on the extent of resection (EOR). The utility of conventional image-guided surgery is limited by intraoperative brain shift. More recent techniques to maximize EOR, including intraoperative imaging and the use of fluorescent dyes, combat these limitations. However, the relative efficacy of these two techniques has never been systematically compared. Thus, the authors performed an exhaustive systematic review in conjunction with quantitative network meta-analyses to evaluate the comparative effectiveness of 5-aminolevulinic acid (5-ALA) and intraoperative MRI (IMRI) in optimizing EOR in HGG. They secondarily analyzed associated progression-free and overall survival and performed subgroup analyses by level of evidence. METHODS PubMed, Embase, Cochrane Central, and Web of Science were searched for studies evaluating conventional neuronavigation, IMRI, and 5-ALA in HGG resection. The primary study endpoint was the proportion of patients attaining gross-total resection (GTR), defined as 100% elimination of contrast-enhancing lesion on postoperative MRI. Secondary endpoints included overall and progression-free survival and subgroup analyses for level of evidence. Comparative efficacy analysis of IMRI and 5-ALA was performed using Bayesian network meta-analysis models. RESULTS This analysis included 11 studies. In a classic meta-analysis, both IMRI (OR 4.99, 95% CI 2.65-9.39, p < 0.001) and 5-ALA (OR 2.866, 95% CI 2.127-3.863, p < 0.001) were superior to conventional navigation in achieving GTR. Bayesian network analysis was employed to indirectly compare IMRI to 5-ALA, and no significant difference in GTR was found between the two (OR 1.9 favoring IMRI, 95% CI 0.905-3.989, p = 0.090). A handful of studies additionally suggested that the use of either IMRI (2 and 4 studies, respectively) or 5-ALA (2 and 2 studies, respectively) improves progression-free and overall survival. CONCLUSIONS IMRI and 5-ALA are individually superior to conventional neuronavigation for achieving GTR of HGG. Between IMRI and 5-ALA, neither method is clearly more effective. Future studies evaluating the comparative cost and surgical time associated with IMRI and 5-ALA will better inform any cost-benefit analysis.
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Affiliation(s)
| | | | - Siddhant Dogra
- 2Radiology, New York University School of Medicine, New York, New York
| | - Joseph Nicholson
- 3NYU Health Sciences Library, New York University School of Medicine, New York, New York
| | - Katherine A Kirkwood
- 4Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Stephen Loftus
- 5Department of Science, Technology, Engineering and Math, Sweet Briar College, Sweet Briar, Virginia
| | - Theodore H Schwartz
- 6Departments of Neurosurgery, Otolaryngology, and Neuroscience, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York; and
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20
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Piao H, Ye D, Yu T, Shi J. Comparison of intraoperative magnetic resonance imaging, ultrasound, 5-aminolevulinic acid, and neuronavigation for guidance in glioma resection: A network meta-analysis. GLIOMA 2020. [DOI: 10.4103/glioma.glioma_5_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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A Multi-Institutional Analysis of Factors Influencing Surgical Outcomes for Patients with Newly Diagnosed Grade I Gliomas. World Neurosurg 2019; 135:e754-e764. [PMID: 31901497 DOI: 10.1016/j.wneu.2019.12.156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the impact of intraoperative magnetic resonance imaging (iMRI), extent of resection (EOR), and other factors on overall survival (OS) and progression-free survival (PFS) for patients with newly diagnosed grade I gliomas. METHODS A multicenter database was queried to identify patients with grade I gliomas. Retrospective analyses assessed the impact of patient, treatment, and tumor characteristics on OS and PFS. RESULTS A total of 284 patients underwent treatment for grade I gliomas, including 248 resections (205 with iMRI, 43 without), 23 biopsies, and 13 laser interstitial thermal therapy treatments. Log-rank analyses of Kaplan-Meier plots showed improved 5-year OS (P = 0.0107) and PFS (P = 0.0009) with increasing EOR, and a trend toward improved 5-year OS for patients with lower American Society of Anesthesiologists score (P = 0.0528). Greater EOR was associated with significantly increased 5-year PFS for pilocytic astrocytoma (P < 0.0001), but not for ganglioglioma (P = 0.10) or dysembryoplastic neuroepithelial tumor (P = 0.57). Temporal tumors (P = 0.04) and location of "other" (P = 0.04) were associated with improved PFS, and occipital/parietal tumors (P = 0.02) were associated with decreased PFS compared with all other locations. Additional tumor resection was performed after iMRI in 49.7% of cases using iMRI, which produced gross total resection in 64% of these additional resection cases. CONCLUSIONS Patients with grade I gliomas have extended OS and PFS, which correlates positively with increasing EOR, especially for patients with pilocytic astrocytoma. iMRI may increase EOR, indicated by the rate of gross total resection after iMRI use but was not independently associated with increased OS or PFS.
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22
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Suero Molina E, Schipmann S, Stummer W. Maximizing safe resections: the roles of 5-aminolevulinic acid and intraoperative MR imaging in glioma surgery-review of the literature. Neurosurg Rev 2019; 42:197-208. [PMID: 28921173 PMCID: PMC6502775 DOI: 10.1007/s10143-017-0907-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/07/2017] [Accepted: 09/06/2017] [Indexed: 12/28/2022]
Abstract
Malignant glioma surgery involves the challenge of preserving the neurological status of patients harboring these lesions while pursuing a maximal tumor resection, which is correlated with overall and progression-free survival. Presently, several tools exist for assisting neurosurgeons in visualizing malignant tissue. Fluorescence-guided surgery (FGS) with 5-aminolevulinic acid (5-ALA) has increasingly been used during the last decade for identifying malignant glioma. Intraoperative magnetic resonance imaging (iMRI), first introduced in the mid-1990s, is being evaluated as a further tool to maximize the extent of resection. We aimed to evaluate the literature and discuss synergies and differences between FGS with 5-ALA and iMRI. We conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. After excluding non-relevant articles, 16 articles were evaluated and included in the qualitative analysis, comprising 2 (n = 2) reviews of the literatures, 1 (n = 1) book chapter, and 13 (n = 13) clinical articles. ALA-induced fluorescence goes beyond the borders of gadolinium contrast enhancement. Several studies stress the synergy between both tools, enabling increase in extent of resection. We point out advantages of combining both methods. iMRI, however, is not widely available, is expensive, and is not recommended as sole resection control tool in high-grade glioma. For these centers, FGS together with mapping and monitoring techniques, neuronavigation and, when needed, intraoperative ultrasound provides an excellent setting for achieving state-of-the-art gross total resection of high-grade gliomas.
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Affiliation(s)
- Eric Suero Molina
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany.
| | - S Schipmann
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
| | - W Stummer
- Department of Neurosurgery, University Hospital of Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Germany
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23
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Abraham P, Sarkar R, Brandel MG, Wali AR, Rennert RC, Lopez Ramos C, Padwal J, Steinberg JA, Santiago-Dieppa DR, Cheung V, Pannell JS, Murphy JD, Khalessi AA. Cost-effectiveness of Intraoperative MRI for Treatment of High-Grade Gliomas. Radiology 2019; 291:689-697. [PMID: 30912721 PMCID: PMC6543900 DOI: 10.1148/radiol.2019182095] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/04/2019] [Accepted: 02/04/2019] [Indexed: 01/19/2023]
Abstract
Background Intraoperative MRI has been shown to improve gross-total resection of high-grade glioma. However, to the knowledge of the authors, the cost-effectiveness of intraoperative MRI has not been established. Purpose To construct a clinical decision analysis model for assessing intraoperative MRI in the treatment of high-grade glioma. Materials and Methods An integrated five-state microsimulation model was constructed to follow patients with high-grade glioma. One-hundred-thousand patients treated with intraoperative MRI were compared with 100 000 patients who were treated without intraoperative MRI from initial resection and debulking until death (median age at initial resection, 55 years). After the operation and treatment of complications, patients existed in one of three health states: progression-free survival (PFS), progressive disease, or dead. Patients with recurrence were offered up to two repeated resections. PFS, valuation of health states (utility values), probabilities, and costs were obtained from randomized controlled trials whenever possible. Otherwise, national databases, registries, and nonrandomized trials were used. Uncertainty in model inputs was assessed by using deterministic and probabilistic sensitivity analyses. A health care perspective was used for this analysis. A willingness-to-pay threshold of $100 000 per quality-adjusted life year (QALY) gained was used to determine cost efficacy. Results Intraoperative MRI yielded an incremental benefit of 0.18 QALYs (1.34 QALYs with intraoperative MRI vs 1.16 QALYs without) at an incremental cost of $13 447 ($176 460 with intraoperative MRI vs $163 013 without) in microsimulation modeling, resulting in an incremental cost-effectiveness ratio of $76 442 per QALY. Because of parameter distributions, probabilistic sensitivity analysis demonstrated that intraoperative MRI had a 99.5% chance of cost-effectiveness at a willingness-to-pay threshold of $100 000 per QALY. Conclusion Intraoperative MRI is likely to be a cost-effective modality in the treatment of high-grade glioma. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Bettmann in this issue.
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Affiliation(s)
- Peter Abraham
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - Reith Sarkar
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - Michael G. Brandel
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - Arvin R. Wali
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - Robert C. Rennert
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - Christian Lopez Ramos
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - Jennifer Padwal
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - Jeffrey A. Steinberg
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - David R. Santiago-Dieppa
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - Vincent Cheung
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - J. Scott Pannell
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - James D. Murphy
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
| | - Alexander A. Khalessi
- From the School of Medicine (P.A., R.S., M.G.B., C.L.R., J.P.),
Department of Neurosurgery (A.R.W., R.C.R., J.A.S., D.R.S.D., V.C., J.S.P.,
A.A.K.), and Department of Radiation Oncology (J.D.M.), University of
California–San Diego, 9300 Campus Point Dr, Mail Code 7893, La Jolla, CA
92037
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Leroy HA, Delmaire C, Le Rhun E, Drumez E, Lejeune JP, Reyns N. High-field intraoperative MRI in glioma surgery: A prospective study with volumetric analysis of extent of resection and functional outcome. Neurochirurgie 2018; 64:155-160. [PMID: 29754739 DOI: 10.1016/j.neuchi.2018.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/14/2018] [Accepted: 02/17/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND High-field intraoperative MRI (IoMRI) is a useful tool to improve the extent of glioma resection (EOR). OBJECTIVE To compare the interest of 1.5T IoMRI in glioma surgery between enhancing and non-enhancing tumors, based on volumetric analysis. METHODS A prospective single-center study included consecutive adult patients undergoing glioma surgery with IoMRI. Volumetric evaluation was based on FLAIR hypersignal after gadolinium injection in non-enhancing tumors and T1 hypersignal after gadolinium injection in enhancing tumors. Endpoints comprised: residual tumor volume (RTV), EOR, workflow and clinical outcome on Karnofsky performance score (KPS). RESULTS Fifty-three surgeries were performed from July 2014 to January 2016. Thirty-four patients underwent one IoMRI, and 19 two IoMRIs. In non-enhancing tumors, intraoperative RTV on 1st IoMRI T2/FLAIR was higher than in enhancing tumors on T1 sequences (7.25cm3 vs. 0.74cm3, respectively; P=0.008), whereas the RTV on 2nd IoMRIs and final RTV were no longer significantly different. After IoMRI, 72% of patients underwent additional resection. In non-enhancing tumors, EOR increased from 77.3% on 1st IoMRI to 97.4% on last MRI (P<0.001). Taking all tumors together, final RTV values were: median=0cm3, mean=3.9cm3. Mean final EOR was 94%. In 25% of patients, KPS was reduced during early postoperative course; at 3 and 6 months postoperatively, median KPS was 90. CONCLUSION Intraoperative MRI guidance significantly enhanced the extent of glioma resection, especially for non- or minimally enhancing tumors, while preserving patient autonomy.
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Affiliation(s)
- H-A Leroy
- Department of Neurosurgery and Neuro-Oncology, CHU de Lille, 59000 Lille, France; Inserm, U1189 - ONCO-THAI - Image-Assisted Laser Therapy for Oncology, University Lille, CHU de Lille, 59000 Lille, France.
| | - C Delmaire
- Department of Radiology, CHU de Lille, 59000 Lille, France
| | - E Le Rhun
- Department of Neurosurgery and Neuro-Oncology, CHU de Lille, 59000 Lille, France
| | - E Drumez
- EA 2694-santé publique : epidémiologie et qualité des soins, Department of Biostatistics, CHU de Lille, University Lille, 59000 Lille, France
| | - J-P Lejeune
- Department of Neurosurgery and Neuro-Oncology, CHU de Lille, 59000 Lille, France
| | - N Reyns
- Department of Neurosurgery and Neuro-Oncology, CHU de Lille, 59000 Lille, France; Inserm, U1189 - ONCO-THAI - Image-Assisted Laser Therapy for Oncology, University Lille, CHU de Lille, 59000 Lille, France
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Intraoperative 3 tesla magnetic resonance imaging: Our experience in tumors. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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García-Baizán A, Tomás-Biosca A, Bartolomé Leal P, Domínguez P, García de Eulate Ruiz R, Tejada S, Zubieta J. Resonancia magnética intraoperatoria de 3 teslas: Nuestra experiencia en patología tumoral. RADIOLOGIA 2018; 60:136-142. [DOI: 10.1016/j.rx.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 11/01/2017] [Accepted: 12/03/2017] [Indexed: 10/18/2022]
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Lukas RV, Wu J, Dey M, Buerki RA, Byrne RW, Dohrmann GJ. A Survey of the Neuro-Oncology Landscape. J Clin Neurol 2018; 14:8-15. [PMID: 29141278 PMCID: PMC5765260 DOI: 10.3988/jcn.2018.14.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 11/17/2022] Open
Abstract
The field of neuro-oncology is evolving rapidly. Many important advances have recently been reported, and other promising investigations have the potential to soon make substantial impacts in the field, especially in the areas of high-grade gliomas and brain metastases. We present an overview of the current status of this field, highlighting the key recent advances as well as representative work of key clinical investigations, since these concepts have the potential to influence clinical management if they are demonstrated to be safe and efficacious. This overview includes some work that has only appeared in abstract form in order to provide a timely understanding of how the field is actively changing and what may lie on the horizon. We focus on both medical and surgical neuro-oncology advances in this highly multidisciplinary subspecialty.
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Affiliation(s)
- Rimas V Lukas
- Department of Neurology, Northwestern University, Chicago, IL, USA.
| | - Jing Wu
- Neuro-Oncology Branch, National Institutes of Health, Bethesda, MD, USA
| | - Mahua Dey
- Department of Neurosurgery, Indiana University, Indianapolis, IN, USA
| | - Robin A Buerki
- Department of Neurosurgery, University of California, San Francisco, CA, USA
| | - Richard W Byrne
- Department of Neurosurgery, Rush University, Chicago, IL, USA
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28
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Capellades J, Puig J, Domenech S, Pujol T, Oleaga L, Camins A, Majós C, Diaz R, de Quintana C, Teixidor P, Conesa G, Plans G, Gonzalez J, García-Balañà N, Velarde JM, Balaña C. Is a pretreatment radiological staging system feasible for suggesting the optimal extent of resection and predicting prognosis in glioblastoma? An observational study. J Neurooncol 2017; 137:367-377. [DOI: 10.1007/s11060-017-2726-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
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Li P, Qian R, Niu C, Fu X. Impact of intraoperative MRI-guided resection on resection and survival in patient with gliomas: a meta-analysis. Curr Med Res Opin 2017; 33:621-630. [PMID: 28008781 DOI: 10.1080/03007995.2016.1275935] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study addressed the benefit of intraoperative magnetic resonance imaging (iMRI) compared with conventional neuronavigation-guided resection in patients with gliomas. RESEARCH DESIGN AND METHODS The Medline, PubMed, Cochrane, and Google Scholar databases were searched up to 26 September 2015. Randomized controlled trials (RCTs), two-arm prospective studies, and retrospective studies in patients with glioblastoma/glioma who had received surgical treatment were included. MAIN OUTCOME MEASURES The primary outcome measures were the extent of tumor resection and tumor size reduction for using iMRI-guided or conventional neuronavigation-guided neurosurgery. Secondary outcomes included impact of surgery on 6 month progression-free survival (PFS), 12 month overall survival (OS) rates and surgical duration. RESULTS We found that iMRI was associated with greater rate of gross total resection (rGTR) compared with conventional neuronavigation procedures (3.16, 95% confidence interval [CI] 2.07-4.83, P < .001). We found no difference between the two neuronavigation approaches in extent of resection (EOR), tumor size reduction, or time required for surgery (P values ≥.065). Intraoperative MRI was associated with a higher rate of progression-free survival (PFS) compared with conventional neuronavigation (odds ratio, 1.84; 95% CI 1.15-2.95; P = .012), but the rate of overall survival (OS) between groups was similar (P = .799). Limitations of the study included the fact that data from non-RCTs was used, the small study population, and heterogeneity of outcomes across studies. CONCLUSIONS Our findings indicate that iMRI more frequently resulted in more complete resections leading to improved PFS in patients with malignant gliomas.
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Affiliation(s)
- Ping Li
- a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China
- b Department of Neurosurgery , South branch of Anhui Provincial Hospital, Anhui Provincial Cardiovascular and Cerebrovascular Hospital , Hefei , Anhui 230001 , P.R. China
| | - Ruobing Qian
- a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China
| | - Chaoshi Niu
- a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China
| | - Xianming Fu
- a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China
- b Department of Neurosurgery , South branch of Anhui Provincial Hospital, Anhui Provincial Cardiovascular and Cerebrovascular Hospital , Hefei , Anhui 230001 , P.R. China
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Swinney C, Li A, Bhatti I, Veeravagu A. Optimization of tumor resection with intra-operative magnetic resonance imaging. J Clin Neurosci 2016; 34:11-14. [PMID: 27469412 DOI: 10.1016/j.jocn.2016.05.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 04/22/2016] [Accepted: 05/09/2016] [Indexed: 11/30/2022]
Abstract
Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technology allows for the removal of residual tumor mass following initial tumor removal, maximizing the extent of resection. This, in turn, has been shown to lead to improved outcomes. Individual studies have examined the impact of ioMRI on the rate of extended resection, but a comprehensive review of this topic is needed. A literature review of the MEDLINE, EMBASE, CENTRAL, and Google Scholar databases revealed 12 eligible studies. This included 804 primary operations and 238 extended resections based on ioMRI findings. Use of ioMRI led to extended tumor resection in 13.3-54.8% of patients (mean 37.3%). Stratification by tumor type showed additional resection occurred, on average, in 39.1% of glioma resections (range 13.3-70.0%), 23.5% of pituitary tumor resections (range 13.3-33.7%), and 35.0% of nonspecific tumor resections (range 17.5-40%). Tumor type (glioma vs. pituitary) did not significantly influence the rate of further excision following ioMRI (p=0.309). There was no difference in secondary resection rate between studies limited to pediatric patients and those including adults (p=0.646). Thus, the use of intra-operative MRI frequently results in further resection of tumors. It is primarily used for the resection of gliomas and pituitary tumors. Tumor type does not appear to be a significant contributing factor to the rate of secondary tumor removal. Limited evidence suggests that extended resection may translate into improved clinical outcomes and mortality rates. However, results have not been unanimous, while clinical effect sizes have often been modest.
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Affiliation(s)
- Christian Swinney
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
| | - Amy Li
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Inderpreet Bhatti
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
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Rennert RC, Santiago-Dieppa DR, Figueroa J, Sanai N, Carter BS. Future directions of operative neuro-oncology. J Neurooncol 2016; 130:377-382. [DOI: 10.1007/s11060-016-2180-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/05/2016] [Indexed: 01/14/2023]
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Osorio JA, Aghi MK. Optimizing glioblastoma resection: intraoperative mapping and beyond. CNS Oncol 2014; 3:359-66. [PMID: 25363008 DOI: 10.2217/cns.14.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The management of glioblastomas starts with surgical resection if possible, along with subsequent chemotherapy and radiation therapy. Several retrospective studies have suggested that extent of resection plays a role in the prognosis of glioblastoma patients. The importance of extent of resection must be balanced with preserving patient's functional status for tumors in eloquent areas. Here we review the preoperative imaging modalities such as functional MRI and magnetoencephalography (MEG), and the intraoperative techniques such as motor and language mapping, intraoperative MRI, and intraoperative techniques such as 5-aminolevulinic acid administration, that allow maximal safe operative resection of glioblastomas.
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Affiliation(s)
- Joseph A Osorio
- Department of Neurological Surgery, University of California, 505 Parnassus Avenue, Room M779, San Francisco, CA 94143-0112, USA
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