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Hu S, Xie L, Zhang Y. Surgical treatment of small recurrent gliomas based on MR imaging examination. Med Eng Phys 2024; 126:104139. [PMID: 38621837 DOI: 10.1016/j.medengphy.2024.104139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/27/2024] [Accepted: 03/02/2024] [Indexed: 04/17/2024]
Abstract
Microrecurrent glioma is a common neurological tumor, and the key to its surgical treatment is to accurately evaluate the size, location and degree of recurrence of the lesion. The purpose of this study was to explore the surgical treatment of microrecurrent glioma based on MR Imaging, and to provide accurate and reliable basis for clinical decision-making. Before surgery, detailed MR Imaging tests were performed for each patient to accurately locate and evaluate the characteristics of the lesions. Multimodal imaging examination were arranged to accurate the pre-operation diagnosis. Neuro-navigation is necessary for the operation design and tumor confirmation. Function monitor and intraoperation MR were prepared when necessary.Mini was defined by the size, location and symptoms. In all 5 cases requiring reoperation, total resection was achieved. No systemic and local complications occurred. No permeant neurological dysfunction remained. The average stay time after the operation is days. All patients survived in the recent follow-up. Reoperation of mini recurrent glioma is a good treatment choice. We made little injury to patients, which wouldn't affect their conditions and next therapies. Through MR Imaging, the diagnosis and location of microrecurrent glioma, as well as the relationship with surrounding tissues and the degree of infiltration, provide important information for surgeons to evaluate the resectable lesion. By combining MR And functional imaging results, the blood supply and functional area of the lesion can be monitored in real time during surgery, thereby reducing surgical risk and maximizing the protection of surrounding healthy tissue.
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Affiliation(s)
- Shukun Hu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; National Center for Neurological Disorders, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; Neurosurgical Institute of Fudan University, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; Shanghai Clinical Medical Center of Neurosurgery, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, 12 Wulumuqi Middle Road, Shanghai 200042, PR China
| | - Liqian Xie
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; National Center for Neurological Disorders, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; Neurosurgical Institute of Fudan University, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; Shanghai Clinical Medical Center of Neurosurgery, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, 12 Wulumuqi Middle Road, Shanghai 200042, PR China
| | - Yi Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; National Center for Neurological Disorders, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; Neurosurgical Institute of Fudan University, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; Shanghai Clinical Medical Center of Neurosurgery, 12 Wulumuqi Middle Road, Shanghai 200042, PR China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, 12 Wulumuqi Middle Road, Shanghai 200042, PR China.
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Schwartz C, Romagna A, Machegger L, Weiss L, Huemer F, Fastner G, Kleindienst W, Weis S, Greil R, Winkler PA. Extensive Leptomeningeal Intracranial and Spinal Metastases in a Patient with a Supratentorial Glioblastoma Multiforme, IDH-Wildtype. World Neurosurg 2018; 120:442-447. [PMID: 30253992 DOI: 10.1016/j.wneu.2018.09.082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is usually characterized by diffuse, infiltrative growth and local tumor progression. Extensive leptomeningeal metastases are rarely observed. It is unclear which GBMs are prone to this specific growth pattern and progression, and standardized salvage treatment protocols are unavailable. CASE DESCRIPTION In a 45-year-old man without focal neurologic deficit, a right temporal GBM, IDH-wildtype (biomarkers MGMT promoter methylation negative, Ki-67 proliferation rate 70%) was diagnosed. Gross tumor resection followed by concomitant and adjuvant radiotherapy and chemotherapy with temozolomide was performed. Routine follow-up imaging 8 months later showed a right parietal meningeal tumor. Resection confirmed a distant GBM, and next-generation sequencing revealed high tumor mutational burden, high-frequency microsatellite instability, and a pharmacologically targetable KIT mutation. Complete neuraxis imaging revealed multiple contrast-enhancing tumors in the craniocervical junction and levels C7, Th8-Th11, and S1. The craniocervical tumors and the cervical spine from C1-C2 were irradiated as palliative care, and second-line combined chemotherapy and antiangiogenic therapy with irinotecan and bevacizumab was initiated, which was later changed to an immune-checkpoint blockade with pembrolizumab in combination with bevacizumab owing to tumor progression. Tumor growth was slowed, but the patient eventually developed a progressive paraparesis. Subsequent KIT-targeting tyrosine kinase inhibitor therapy with imatinib was administered for a short time. The patient died 13.8 months after initial diagnosis. CONCLUSIONS High-risk genetic profiles for GBMs prone to develop extensive leptomeningeal metastases need to be identified. Guidelines on preemptive, complete neuraxis imaging in certain patients with GBM as well as treatment guidelines need to be developed.
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Affiliation(s)
- Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Alexander Romagna
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Machegger
- Division of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University, Salzburg, Austria
| | - Florian Huemer
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University, Salzburg, Austria
| | - Gerd Fastner
- Department of Radiotherapy and Radio-Oncology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Waltraud Kleindienst
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Serge Weis
- Division of Neuropathology, Institute of Pathology and Microbiology, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - Peter A Winkler
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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Schwartz C, Romagna A, Winkler PA. In Reply to the Letter to the Editor “Probiotics: Novel Addition to Antiglioma Armamentarium”. World Neurosurg 2018; 113:377. [DOI: 10.1016/j.wneu.2018.01.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/27/2018] [Indexed: 10/17/2022]
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Derakhshan P, Derakhshan N, Saffarian A, Taghipour M. Probiotics: Novel Addition to Antiglioma Armamentarium. World Neurosurg 2018; 113:376. [DOI: 10.1016/j.wneu.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 11/17/2022]
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