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Ember K, Dallaire F, Plante A, Sheehy G, Guiot MC, Agarwal R, Yadav R, Douet A, Selb J, Tremblay JP, Dupuis A, Marple E, Urmey K, Rizea C, Harb A, McCarthy L, Schupper A, Umphlett M, Tsankova N, Leblond F, Hadjipanayis C, Petrecca K. In situ brain tumor detection using a Raman spectroscopy system-results of a multicenter study. Sci Rep 2024; 14:13309. [PMID: 38858389 PMCID: PMC11164901 DOI: 10.1038/s41598-024-62543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 05/17/2024] [Indexed: 06/12/2024] Open
Abstract
Safe and effective brain tumor surgery aims to remove tumor tissue, not non-tumoral brain. This is a challenge since tumor cells are often not visually distinguishable from peritumoral brain during surgery. To address this, we conducted a multicenter study testing whether the Sentry System could distinguish the three most common types of brain tumors from brain tissue in a label-free manner. The Sentry System is a new real time, in situ brain tumor detection device that merges Raman spectroscopy with machine learning tissue classifiers. Nine hundred and seventy-six in situ spectroscopy measurements and colocalized tissue specimens were acquired from 67 patients undergoing surgery for glioblastoma, brain metastases, or meningioma to assess tumor classification. The device achieved diagnostic accuracies of 91% for glioblastoma, 97% for brain metastases, and 96% for meningiomas. These data show that the Sentry System discriminated tumor containing tissue from non-tumoral brain in real time and prior to resection.
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Affiliation(s)
- Katherine Ember
- Polytechnique Montréal, Montreal, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Frédérick Dallaire
- Polytechnique Montréal, Montreal, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Arthur Plante
- Polytechnique Montréal, Montreal, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Guillaume Sheehy
- Polytechnique Montréal, Montreal, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Marie-Christine Guiot
- Division of Neuropathology, Department of Pathology, Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Frédéric Leblond
- Polytechnique Montréal, Montreal, Canada.
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
- Institut du Cancer de Montréal, Montreal, Canada.
| | - Constantinos Hadjipanayis
- Mount Sinai Hospital, New York, NY, USA.
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Kevin Petrecca
- Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada.
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2
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Mut M, Zhang M, Gupta I, Fletcher PT, Farzad F, Nwafor D. Augmented surgical decision-making for glioblastoma: integrating AI tools into education and practice. Front Neurol 2024; 15:1387958. [PMID: 38911587 PMCID: PMC11191873 DOI: 10.3389/fneur.2024.1387958] [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: 02/19/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
Surgical decision-making for glioblastoma poses significant challenges due to its complexity and variability. This study investigates the potential of artificial intelligence (AI) tools in improving "decision-making processes" for glioblastoma surgery. A systematic review of literature identified 10 relevant studies, primarily focused on predicting resectability and surgery-related neurological outcomes. AI tools, especially rooted in radiomics and connectomics, exhibited promise in predicting resection extent through precise tumor segmentation and tumor-network relationships. However, they demonstrated limited effectiveness in predicting postoperative neurological due to dynamic and less quantifiable nature of patient-related factors. Recognizing these challenges, including limited datasets and the interpretability requirement in medical applications, underscores the need for standardization, algorithm optimization, and addressing variability in model performance and then further validation in clinical settings. While AI holds potential, it currently does not possess the capacity to emulate the nuanced decision-making process utilized by experienced neurosurgeons in the comprehensive approach to glioblastoma surgery.
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Affiliation(s)
- Melike Mut
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
| | - Miaomiao Zhang
- Department of Electrical and Computer Engineering, Department of Computer Science, University of Virginia, Charlottesville, VA, United States
| | - Ishita Gupta
- Department of Electrical and Computer Engineering, Department of Computer Science, University of Virginia, Charlottesville, VA, United States
| | - P. Thomas Fletcher
- Department of Electrical and Computer Engineering, Department of Computer Science, University of Virginia, Charlottesville, VA, United States
| | - Faraz Farzad
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
| | - Divine Nwafor
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
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3
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Luckett PH, Olufawo MO, Park KY, Lamichhane B, Dierker D, Verastegui GT, Lee JJ, Yang P, Kim A, Butt OH, Chheda MG, Snyder AZ, Shimony JS, Leuthardt EC. Predicting post-surgical functional status in high-grade glioma with resting state fMRI and machine learning. J Neurooncol 2024:10.1007/s11060-024-04715-1. [PMID: 38789843 DOI: 10.1007/s11060-024-04715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE High-grade glioma (HGG) is the most common and deadly malignant glioma of the central nervous system. The current standard of care includes surgical resection of the tumor, which can lead to functional and cognitive deficits. The aim of this study is to develop models capable of predicting functional outcomes in HGG patients before surgery, facilitating improved disease management and informed patient care. METHODS Adult HGG patients (N = 102) from the neurosurgery brain tumor service at Washington University Medical Center were retrospectively recruited. All patients completed structural neuroimaging and resting state functional MRI prior to surgery. Demographics, measures of resting state network connectivity (FC), tumor location, and tumor volume were used to train a random forest classifier to predict functional outcomes based on Karnofsky Performance Status (KPS < 70, KPS ≥ 70). RESULTS The models achieved a nested cross-validation accuracy of 94.1% and an AUC of 0.97 in classifying KPS. The strongest predictors identified by the model included FC between somatomotor, visual, auditory, and reward networks. Based on location, the relation of the tumor to dorsal attention, cingulo-opercular, and basal ganglia networks were strong predictors of KPS. Age was also a strong predictor. However, tumor volume was only a moderate predictor. CONCLUSION The current work demonstrates the ability of machine learning to classify postoperative functional outcomes in HGG patients prior to surgery accurately. Our results suggest that both FC and the tumor's location in relation to specific networks can serve as reliable predictors of functional outcomes, leading to personalized therapeutic approaches tailored to individual patients.
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Affiliation(s)
- Patrick H Luckett
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Michael O Olufawo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ki Yun Park
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Bidhan Lamichhane
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Center for Health Sciences, Oklahoma State University, Tulsa, OK, USA
| | - Donna Dierker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - John J Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Peter Yang
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Albert Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Omar H Butt
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Milan G Chheda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in Saint Louis, St. Louis, MO, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
- Department of Mechanical Engineering and Materials Science, Washington University in Saint Louis, St. Louis, MO, USA
- Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, MO, USA
- Brain Laser Center, Washington University School of Medicine, St. Louis, MO, USA
- National Center for Adaptive Neurotechnologies, Albany, NY, USA
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Pacult MA, Przybylowski CJ, Raza SM, DeMonte F. Surgical Management of High-Grade Meningiomas. Cancers (Basel) 2024; 16:1978. [PMID: 38893100 PMCID: PMC11171173 DOI: 10.3390/cancers16111978] [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: 08/24/2023] [Revised: 09/27/2023] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Maximal resection with the preservation of neurological function are the mainstays of the surgical management of high-grade meningiomas. Surgical morbidity is strongly associated with tumor size, location, and invasiveness, whereas patient survival is strongly associated with the extent of resection, tumor biology, and patient health. A versatile microsurgical skill set combined with a cogent multimodality treatment plan is critical in order to achieve optimal patient outcomes. Continued refinement in surgical techniques in conjunction with directed radiotherapeutic and medical therapies will define future treatment.
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Affiliation(s)
- Mark A. Pacult
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA;
| | - Colin J. Przybylowski
- Division of Neurosurgery, Fukushima Brain Tumor Center, Raleigh Neurosurgical Clinic, Raleigh, NC 27609, USA;
| | - Shaan M. Raza
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA;
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA;
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Veljanoski D, Ng XY, Hill CS, Jamjoom AAB. Theory and evidence-base for a digital platform for the delivery of language tests during awake craniotomy and collaborative brain mapping. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000234. [PMID: 38756704 PMCID: PMC11097893 DOI: 10.1136/bmjsit-2023-000234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives Build the theoretical and evidence-base for a digital platform (map-OR) which delivers intraoperative language tests during awake craniotomy and facilitates collaborative sharing of brain mapping data. Design Mixed methodology study including two scoping reviews, international survey, synthesis of development guiding principles and a risk assessment using failure modes and effects analysis. Setting The two scoping reviews examined the literature published in the English language. International survey was completed by members of awake craniotomy teams from 14 countries. Main outcome measures Scoping review 1: number of technologies described for language mapping during awake craniotomy. Scoping review 2: barriers and facilitators to adopting novel technology in surgery. International survey: degree of language mapping technology penetration into clinical practice. Results A total of 12 research articles describing 6 technologies were included. The technologies required a range of hardware components including portable devices, virtual reality headsets and large integrated multiscreen stacks. The facilitators and barriers of technology adoption in surgery were extracted from 11 studies and mapped onto the 4 Unified Theory of Acceptance and Use of Technology constructs. A total of 37 awake craniotomy teams from 14 countries completed the survey. Of the responses, 20 (54.1%) delivered their language tests digitally, 10 (27.0%) delivered tests using cards and 7 (18.9%) used a combination of both. The most commonly used devices were tablet computers (67.7%; n=21) and the most common software used was Microsoft PowerPoint (60.6%; n=20). Four key risks for the proposed digital platform were identified, the highest risk being a software and internet connectivity failure during surgery. Conclusions This work represents a rigorous and structured approach to the development of a digital platform for standardized intraoperative language testing during awake craniotomy and for collaborative sharing of brain mapping data. Trial registration number Scoping review protocol registrations in OSF registries (scoping review 1: osf.io/su9xm; scoping review 2: osf.io/x4wsc).
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Affiliation(s)
| | - Xin Yi Ng
- Department of Medicine, Arrowe Park Hospital, Wirral, UK
| | - Ciaran Scott Hill
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Aimun A B Jamjoom
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Department of Neurosurgery, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
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Koay JM, Michaelides L, Moniz-Garcia DP, Quinones-Hinojosa A, Chaichana K, Almeida JP, Gruenbaum BF, Sherman WJ, Sabsevitz DS. Repeated surgical resections for management of high-grade glioma and its impact on quality of life. J Neurooncol 2024; 167:267-273. [PMID: 38349476 DOI: 10.1007/s11060-024-04600-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE High-grade gliomas (HGG) are aggressive cancers, and their recurrence is inevitable, despite advances in treatment options. While repeated tumor resection has been shown to increase survival rate, its impact on quality of life is not clearly defined. To address this gap, we compared quality of life (QoL) changes in HGG patients who underwent first-time (FTR) versus repeat surgical resections (RSR) for management of recurrence. METHODS Forty-four adults with HGG who underwent tumor resection were included in this study and classified into either the FTR group (n = 23) or the RSR group (n = 21). All patients completed comprehensive neuropsychological evaluations that included the Functional Assessment of Cancer Therapy-General (FACT-G) and Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) scales, pre-operatively and at two weeks post-operatively. RESULTS There was no difference between the FTR and RSR groups in any of the QoL indices (all p > .05), except for improved emotional well-being and worsened social well-being, suggesting minimal detrimental effects of repeat surgeries on QoL in comparison to first time surgery. CONCLUSIONS These results suggest that repeated resection is a viable strategy in certain cases for management of HGG recurrence, with similar impact on QoL as observed in patients undergoing first time surgery. These encouraging outcomes provide useful insight to guide treatment strategies and patient and clinician decision making to optimize surgical and functional outcomes.
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Affiliation(s)
- Jun Min Koay
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA.
| | | | | | | | - Kaisorn Chaichana
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Benjamin F Gruenbaum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Wendy J Sherman
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - David S Sabsevitz
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
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Eibl T, Schrey M, Liebert A, Ritter L, Lange R, Steiner HH, Schebesch KM. Significance of navigated transcranial magnetic stimulation and tractography to preserve motor function in patients undergoing surgery for motor eloquent gliomas. Heliyon 2024; 10:e28115. [PMID: 38533081 PMCID: PMC10963369 DOI: 10.1016/j.heliyon.2024.e28115] [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: 01/24/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
Resection of gliomas in or close to motor areas is at high risk for morbidity and development of surgery-related deficits. Navigated transcranial magnetic stimulation (nTMS) including nTMS-based tractography is suitable for presurgical planning and risk assessment. The aim of this study was to investigate the association of postoperative motor status and the spatial relation to motor eloquent brain tissue in order to increase the understanding of postoperative motor deficits. Patient data, nTMS examinations and imaging studies were retrospectively reviewed, corticospinal tracts (CST) were reconstructed with two different approaches of nTMS-based seeding. Postoperative imaging and nTMS-augmented preoperative imaging were merged to identify the relation between motor positive cortical and subcortical areas and the resection cavity. 38 tumor surgeries were performed in 36 glioma patients (28.9% female) aged 55.1 ± 13.8 years. Mean distance between the CST and the lesion was 6.9 ± 5.1 mm at 75% of the patient-individual fractional anisotropy threshold and median tumor volume reduction was 97.7 ± 11.6%. The positive predictive value for permanent deficits after resection of nTMS positive areas was 66.7% and the corresponding negative predictive value was 90.6%. Distances between the resection cavity and the CST were higher in patients with postoperative stable motor function. Extent of resection and distance between resection cavity and CST correlated well. The present study strongly supports preoperative nTMS as an important surgical tool for preserving motor function in glioma patients at risk.
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Affiliation(s)
- Thomas Eibl
- Department of Neurosurgery, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Bavaria, Germany
| | - Michael Schrey
- Department of Neurosurgery, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Bavaria, Germany
| | - Adrian Liebert
- Department of Neurosurgery, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Bavaria, Germany
| | - Leonard Ritter
- Department of Neurosurgery, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Bavaria, Germany
| | - Rüdiger Lange
- Department of Neurology, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Bavaria, Germany
| | - Hans-Herbert Steiner
- Department of Neurosurgery, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Bavaria, Germany
| | - Karl-Michael Schebesch
- Department of Neurosurgery, Paracelsus Medical University, Breslauer Str. 201, 90471, Nuremberg, Bavaria, Germany
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Staub-Bartelt F, Suresh Babu MP, Szelényi A, Rapp M, Sabel M. Establishment of Different Intraoperative Monitoring and Mapping Techniques and Their Impact on Survival, Extent of Resection, and Clinical Outcome in Patients with High-Grade Gliomas-A Series of 631 Patients in 14 Years. Cancers (Basel) 2024; 16:926. [PMID: 38473288 DOI: 10.3390/cancers16050926] [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: 12/12/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The resection of brain tumors can be critical concerning localization, but is a key point in treating gliomas. Intraoperative neuromonitoring (IONM), awake craniotomy, and mapping procedures have been incorporated over the years. Using these intraoperative techniques, the resection of eloquent-area tumors without increasing postoperative morbidity became possible. This study aims to analyze short-term and particularly long-term outcomes in patients diagnosed with high-grade glioma, who underwent surgical resection under various technical intraoperative settings over 14 years. METHODS A total of 1010 patients with high-grade glioma that underwent resection between 2004 and 2018 under different monitoring or mapping procedures were screened; 631 were considered eligible for further analyses. We analyzed the type of surgery (resection vs. biopsy) and type of IONM or mapping procedures that were performed. Furthermore, the impact on short-term (The National Institute of Health Stroke Scale, NIHSS; Karnofsky Performance Scale, KPS) and long-term (progression-free survival, PFS; overall survival, OS) outcomes was analyzed. Additionally, the localization, extent of resection (EOR), residual tumor volume (RTV), IDH status, and adjuvant therapy were approached. RESULTS In 481 patients, surgery, and in 150, biopsies were performed. The number of biopsies decreased significantly with the incorporation of awake surgeries with bipolar stimulation, IONM, and/or monopolar mapping (p < 0.001). PFS and OS were not significantly influenced by any intraoperative technical setting. EOR and RTV achieved under different operative techniques showed no statistical significance (p = 0.404 EOR, p = 0.186 RTV). CONCLUSION Based on the present analysis using data from 14 years and more than 600 patients, we observed that through the implementation of various monitoring and mapping techniques, a significant decrease in biopsies and an increase in the resection of eloquent tumors was achieved. With that, the operability of eloquent tumors without a negative influence on neurological outcomes is suggested by our data. However, a statistical effect of monitoring and mapping procedures on long-term outcomes such as PFS and OS could not be shown.
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Affiliation(s)
- Franziska Staub-Bartelt
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | | | - Andrea Szelényi
- Department of Neurosurgery, LMU University Hospital, LMU Munich, 80539 München, Germany
| | - Marion Rapp
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Michael Sabel
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
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Bakhtiyari-Ramezani M, Nohekhan M, Akbari ME, Abbasvandi F, Bayat M, Akbari A, Nasiri M. Comparative assessment of direct and indirect cold atmospheric plasma effects, based on helium and argon, on human glioblastoma: an in vitro and in vivo study. Sci Rep 2024; 14:3578. [PMID: 38347045 PMCID: PMC10861458 DOI: 10.1038/s41598-024-54070-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/08/2024] [Indexed: 02/15/2024] Open
Abstract
Recent research has highlighted the promising potential of cold atmospheric plasma (CAP) in cancer therapy. However, variations in study outcomes are attributed to differences in CAP devices and plasma parameters, which lead to diverse compositions of plasma products, including electrons, charged particles, reactive species, UV light, and heat. This study aimed to evaluate and compare the optimal exposure time, duration, and direction-dependent cellular effects of two CAPs, based on argon and helium gases, on glioblastoma U-87 MG cancer cells and an animal model of GBM. Two plasma jets were used as low-temperature plasma sources in which helium or argon gas was ionized by high voltage (4.5 kV) and frequency (20 kHz). In vitro assessments on human GBM and normal astrocyte cell lines, using MTT assays, flow cytometry analysis, wound healing assays, and immunocytochemistry for Caspase3 and P53 proteins, demonstrated that all studied plasma jets, especially indirect argon CAP, selectively induced apoptosis, hindered tumor cell growth, and inhibited migration. These effects occurred concurrently with increased intracellular levels of reactive oxygen species and decreased total antioxidant capacity in the cells. In vivo results further supported these findings, indicating that single indirect argon and direct helium CAP therapy, equal to high dose Temozolomide treatment, induced tumor cell death in a rat model of GBM. This was concurrent with a reduction in tumor size observed through PET-CT scan imaging and a significant increase in the survival rate. Additionally, there was a decrease in GFAP protein levels, a significant GBM tumor marker, and an increase in P53 protein expression based on immunohistochemical analyses. Furthermore, Ledge beam test analysis revealed general motor function improvement after indirect argon CAP therapy, similar to Temozolomide treatment. Taken together, these results suggest that CAP therapy, using indirect argon and direct helium jets, holds great promise for clinical applications in GBM treatment.
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Affiliation(s)
- Mahdiyeh Bakhtiyari-Ramezani
- Plasma Physics and Nuclear Fusion Research School, Nuclear Science and Technology Research Institute (NSTRI), P.O. Box: 14399-53991, Tehran, Iran.
| | - Mojtaba Nohekhan
- Plasma Physics and Nuclear Fusion Research School, Nuclear Science and Technology Research Institute (NSTRI), P.O. Box: 14399-53991, Tehran, Iran
| | | | - Fereshteh Abbasvandi
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- ATMP Department, Breast Cancer Research Center, Motamed Cancer Research Institute, ACECR, Tehran, Iran
| | - Mahdis Bayat
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- ATMP Department, Breast Cancer Research Center, Motamed Cancer Research Institute, ACECR, Tehran, Iran
| | - Atieh Akbari
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meysam Nasiri
- Department of Cellular and Molecular Biology, School of Biology, Damghan University, Damghan, Iran
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10
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Chohan MO, Flores RA, Wertz C, Jung RE. "Non-Eloquent" brain regions predict neuropsychological outcome in tumor patients undergoing awake craniotomy. PLoS One 2024; 19:e0284261. [PMID: 38300915 PMCID: PMC10833519 DOI: 10.1371/journal.pone.0284261] [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: 10/20/2022] [Accepted: 03/28/2023] [Indexed: 02/03/2024] Open
Abstract
Supratotal resection of primary brain tumors is being advocated especially when involving "non-eloquent" tissue. However, there is extensive neuropsychological data implicating functions critical to higher cognition in areas considered "non-eloquent" by most surgeons. The goal of the study was to determine pre-surgical brain regions that would be predictive of cognitive outcome at 4-6 months post-surgery. Cortical reconstruction and volumetric segmentation were performed with the FreeSurfer-v6.0 image analysis suite. Linear regression models were used to regress cortical volumes from both hemispheres, against the total cognitive z-score to determine the relationship between brain structure and broad cognitive functioning while controlling for age, sex, and total segmented brain volume. We identified 62 consecutive patients who underwent planned awake resections of primary (n = 55, 88%) and metastatic at the University of New Mexico Hospital between 2015 and 2019. Of those, 42 (23 males, 25 left hemispheric lesions) had complete pre and post-op neuropsychological data available and were included in this study. Overall, total neuropsychological functioning was somewhat worse (p = 0.09) at post-operative neuropsychological outcome (Mean = -.20) than at baseline (Mean = .00). Patients with radiation following resection (n = 32) performed marginally worse (p = .036). We found that several discrete brain volumes obtained pre-surgery predicted neuropsychological outcome post-resection. For the total sample, these volumes included: left fusiform, right lateral orbital frontal, right post central, and right paracentral regions. Regardless of lesion lateralization, volumes within the right frontal lobe, and specifically right orbitofrontal cortex, predicted neuropsychological difference scores. The current study highlights the gaps in our current understanding of brain eloquence. We hypothesize that the volume of tissue within the right lateral orbital frontal lobe represents important cognitive reserve capacity in patients undergoing tumor surgery. Our data also cautions the neurosurgeon when considering supratotal resections of tumors that do not extend into areas considered "non-eloquent" by current standards.
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Affiliation(s)
- Muhammad Omar Chohan
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Ranee Ann Flores
- Department of Neurosurgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Christopher Wertz
- Department of Neurosurgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Rex Eugene Jung
- Department of Neurosurgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
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Noll KR, Asman P, Tasnim I, Hall M, Connelly K, Swamy C, Ene C, Tummala S, Grasu RM, Liu HL, Kumar VA, Muir M, Prinsloo S, Michener H, Wefel JS, Ince NF, Prabhu SS. Intraoperative language mapping guided by real-time visualization of gamma band modulation electrocorticograms: Case report and proof of concept. Neurooncol Pract 2024; 11:92-100. [PMID: 38222047 PMCID: PMC10785572 DOI: 10.1093/nop/npad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Electrocorticography (ECoG) language mapping is often performed extraoperatively, frequently involves offline processing, and relationships with direct cortical stimulation (DCS) remain variable. We sought to determine the feasibility and preliminary utility of an intraoperative language mapping approach guided by real-time visualization of electrocorticograms. Methods A patient with astrocytoma underwent awake craniotomy with intraoperative language mapping, utilizing a dual iPad stimulus presentation system coupled to a real-time neural signal processing platform capable of both ECoG recording and delivery of DCS. Gamma band modulations in response to 4 language tasks at each electrode were visualized in real-time. Next, DCS was conducted for each neighboring electrode pair during language tasks. Results All language tasks resulted in strongest heat map activation at an electrode pair in the anterior to mid superior temporal gyrus. Consistent speech arrest during DCS was observed for Object and Action naming tasks at these same electrodes, indicating good correspondence with ECoG heat map recordings. This region corresponded well with posterior language representation via preoperative functional MRI. Conclusions Intraoperative real-time visualization of language task-based ECoG gamma band modulation is feasible and may help identify targets for DCS. If validated, this may improve the efficiency and accuracy of intraoperative language mapping.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priscella Asman
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Israt Tasnim
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Matthew Hall
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Katherine Connelly
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chandra Swamy
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Chibawanye Ene
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roxana M Grasu
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew Muir
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hayley Michener
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nuri F Ince
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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12
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Sattari SA, Rincon-Torroella J, Sattari AR, Feghali J, Yang W, Kim JE, Xu R, Jackson CM, Mukherjee D, Lin SC, Gallia GL, Comair YG, Weingart J, Huang J, Bettegowda C. Awake Versus Asleep Craniotomy for Patients With Eloquent Glioma: A Systematic Review and Meta-Analysis. Neurosurgery 2024; 94:38-52. [PMID: 37489887 DOI: 10.1227/neu.0000000000002612] [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: 03/21/2023] [Accepted: 05/22/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Awake vs asleep craniotomy for patients with eloquent glioma is debatable. This systematic review and meta-analysis sought to compare awake vs asleep craniotomy for the resection of gliomas in the eloquent regions. METHODS MEDLINE and PubMed were searched from inception to December 13, 2022. Primary outcomes were the extent of resection (EOR), overall survival (month), progression-free survival (month), and rates of neurological deficit, Karnofsky performance score, and seizure freedom at the 3-month follow-up. Secondary outcomes were duration of operation (minute) and length of hospital stay (LOS) (day). RESULTS Fifteen studies yielded 2032 patients, from which 800 (39.4%) and 1232 (60.6%) underwent awake and asleep craniotomy, respectively. The meta-analysis concluded that the awake group had greater EOR (mean difference [MD] = MD = 8.52 [4.28, 12.76], P < .00001), overall survival (MD = 2.86 months [1.35, 4.37], P = .0002), progression-free survival (MD = 5.69 months [0.75, 10.64], P = .02), 3-month postoperative Karnofsky performance score (MD = 13.59 [11.08, 16.09], P < .00001), and 3-month postoperative seizure freedom (odds ratio = 8.72 [3.39, 22.39], P < .00001). Furthermore, the awake group had lower 3-month postoperative neurological deficit (odds ratio = 0.47 [0.28, 0.78], P = .004) and shorter LOS (MD = -2.99 days [-5.09, -0.88], P = .005). In addition, the duration of operation was similar between the groups (MD = 37.88 minutes [-34.09, 109.86], P = .30). CONCLUSION Awake craniotomy for gliomas in the eloquent regions benefits EOR, survival, postoperative neurofunctional outcomes, and LOS. When feasible, the authors recommend awake craniotomy for surgical resection of gliomas in the eloquent regions.
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Affiliation(s)
- Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Jordina Rincon-Torroella
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Ali Reza Sattari
- Department of Surgery, Saint Agnes Hospital, Baltimore , Maryland , USA
| | - James Feghali
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Jennifer E Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Shih-Chun Lin
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Youssef G Comair
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Jon Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
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13
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Papadopoulou A, Kumar NS. Prognostic Factors and Resectability Predictors in Insular Gliomas: A Systematic Review. J Neurol Surg A Cent Eur Neurosurg 2024; 85:74-87. [PMID: 37619597 PMCID: PMC10764153 DOI: 10.1055/s-0043-1769128] [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: 01/08/2023] [Accepted: 04/03/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Insular gliomas (INGs) remain a surgically intimidating glioma subgroup encased by eloquent cortical parcels and white matter language tracts, and traversed by multiple middle cerebral artery branches. The predictive power of prognostic factors affecting overall survival (OS), progression-free survival (PFS), and resectability of INGs remain disputed. This comprehensive systematic review analyses prognostic factors and resectability predictors of INGs substantiating pragmatic management options. MATERIALS AND METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) and the Cochrane Handbook of Systematic Reviews of Interventions guidelines. The PubMed, MEDLINE, and Embase databases were searched in April 2022. All clinical studies with ≥10 patients harboring INGs with any intervention and reporting predictors of OS, PFS, and tumor resectability in INGs were included. Molecular ING prognosticators were also included. Studies combining insular and other gliomas analysis, case studies, experimental and animal studies, conference abstracts, letters to the editor, and articles in other languages were excluded. RESULTS Of the 2,384 articles returned, 27 fulfilled the inclusion criteria totaling 1,985 patients. The review yielded 18 OS and 17 PFS prognosticators. These were classified as preoperative (radiologic; clinical), intraoperative, and postoperative (molecular; histopathologic; clinical) prognosticators. In addition, 21 resectability predictors were categorized as preoperative (radiologic; clinical), intraoperative (surgical approach and assistive technology), and postoperative (histopathologic; clinical). The quality assessment revealed 24/27 studies had low risk of bias. One study with moderate and two studies with high risk of bias were included. CONCLUSION Negative prognosticators reported in ≥2 studies included putaminal or paralimbic involvement and higher tumor grade, while seizures at presentation, isocitrate dehydrogenase (IDH) mutation, increased extent of resection, and higher Karnofsky Performance Status preoperatively and at 3 months postoperation were positive prognosticators. Resectability predictors reported in ≥2 studies included the positive predictors of zone I/zone IV tumor location and intraoperative imaging use and the negative predictor of encased lenticulostriate arteries. Paralimbic INGs are not a single entity with homogeneous prognosis. Integration of identified prognosticators in a prospective trial to devise a grading system for INGs can improve clinical decision-making.
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Affiliation(s)
- Ariadni Papadopoulou
- Division of Medicine, University College London Medical School, London, United Kingdom of Great Britain and Northern Ireland
| | - Niraj S. Kumar
- Division of Medicine, University College London Medical School, London, United Kingdom of Great Britain and Northern Ireland
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14
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Young JS, Morshed RA, Hervey-Jumper SL, Berger MS. The surgical management of diffuse gliomas: Current state of neurosurgical management and future directions. Neuro Oncol 2023; 25:2117-2133. [PMID: 37499054 PMCID: PMC10708937 DOI: 10.1093/neuonc/noad133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Indexed: 07/29/2023] Open
Abstract
After recent updates to the World Health Organization pathological criteria for diagnosing and grading diffuse gliomas, all major North American and European neuro-oncology societies recommend a maximal safe resection as the initial management of a diffuse glioma. For neurosurgeons to achieve this goal, the surgical plan for both low- and high-grade gliomas should be to perform a supramaximal resection when feasible based on preoperative imaging and the patient's performance status, utilizing every intraoperative adjunct to minimize postoperative neurological deficits. While the surgical approach and technique can vary, every effort must be taken to identify and preserve functional cortical and subcortical regions. In this summary statement on the current state of the field, we describe the tools and technologies that facilitate the safe removal of diffuse gliomas and highlight intraoperative and postoperative management strategies to minimize complications for these patients. Moreover, we discuss how surgical resections can go beyond cytoreduction by facilitating biological discoveries and improving the local delivery of adjuvant chemo- and radiotherapies.
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Affiliation(s)
- Jacob S Young
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Ramin A Morshed
- Department of Neurological Surgery, University of California, San Francisco, USA
| | | | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, USA
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15
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Vitulli F, Kalaitzoglou D, Soumpasis C, Díaz-Baamonde A, Mosquera JDS, Gullan R, Vergani F, Ashkan K, Bhangoo R, Mirallave-Pescador A, Lavrador JP. Cortical-Subcortical Functional Preservation and Rehabilitation in Neuro-Oncology: Tractography-MIPS-IONM-TMS Proof-of-Concept Study. J Pers Med 2023; 13:1278. [PMID: 37623528 PMCID: PMC10455135 DOI: 10.3390/jpm13081278] [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: 07/01/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
Surgical management of deep-seated brain tumors requires precise functional navigation and minimally invasive surgery. Preoperative mapping using navigated transcranial magnetic stimulation (nTMS), intraoperative neurophysiological monitoring (IONM), and minimally invasive parafascicular surgery (MIPS) act together in a functional-sparing approach. nTMS also provides a rehabilitation tool to maximize functional recovery. This is a single-center retrospective proof-of-concept cohort study between January 2022 and June 2023 of patients admitted for surgery with motor eloquent deep-seated brain tumors. The study enrolled seven adult patients, five females and two males, with a mean age of 56.28 years old. The lesions were located in the cingulate gyrus (three patients), the central core (two patients), and the basal ganglia (two patients). All patients had preoperative motor deficits. The most common histological diagnosis was metastasis (five patients). The MIPS approach to the mid-cingulate lesions involved a trajectory through the fronto-aslant tract (FAT) and the fronto-striatal tract (FST). No positive nTMS motor responses were resected as part of the outer corridor for MIPS. Direct cortical stimulation produced stable motor-evoked potentials during the surgeries with no warning signs. Gross total resection (GTR) was achieved in three patients and near-total resection (NTR) in four patients. Post-operatively, all patients had a deterioration of motor function with no ischemia in the postoperative imaging (cavity-to-CST distance 0-4 mm). After nTMS with low-frequency stimulation in the contralateral motor cortex, six patients recovered to their preoperative functional status and one patient improved to a better functional condition. A combined Tractography-MIPS-IONM-TMS approach provides a successful functional-sparing approach to deep-seated motor eloquent tumors and a rehabilitation framework for functional recovery after surgery.
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Affiliation(s)
- Francesca Vitulli
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (F.V.); (C.S.); (R.G.); (F.V.); (K.A.); (R.B.); (A.M.-P.); (J.P.L.)
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, University of Naples, “Federico II”, Via S. Pansini, 80131 Naples, Italy
| | - Dimitrios Kalaitzoglou
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (F.V.); (C.S.); (R.G.); (F.V.); (K.A.); (R.B.); (A.M.-P.); (J.P.L.)
| | - Christos Soumpasis
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (F.V.); (C.S.); (R.G.); (F.V.); (K.A.); (R.B.); (A.M.-P.); (J.P.L.)
| | - Alba Díaz-Baamonde
- Department of Neurophysiology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (A.D.-B.); (J.D.S.M.)
| | - José David Siado Mosquera
- Department of Neurophysiology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (A.D.-B.); (J.D.S.M.)
| | - Richard Gullan
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (F.V.); (C.S.); (R.G.); (F.V.); (K.A.); (R.B.); (A.M.-P.); (J.P.L.)
| | - Francesco Vergani
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (F.V.); (C.S.); (R.G.); (F.V.); (K.A.); (R.B.); (A.M.-P.); (J.P.L.)
| | - Keyoumars Ashkan
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (F.V.); (C.S.); (R.G.); (F.V.); (K.A.); (R.B.); (A.M.-P.); (J.P.L.)
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (F.V.); (C.S.); (R.G.); (F.V.); (K.A.); (R.B.); (A.M.-P.); (J.P.L.)
| | - Ana Mirallave-Pescador
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (F.V.); (C.S.); (R.G.); (F.V.); (K.A.); (R.B.); (A.M.-P.); (J.P.L.)
- Department of Neurophysiology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (A.D.-B.); (J.D.S.M.)
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (F.V.); (C.S.); (R.G.); (F.V.); (K.A.); (R.B.); (A.M.-P.); (J.P.L.)
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16
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Catalino MP, Buss E, Chamberlin G, Trembath D, Morgan D, Krebs M, Ewend MG, Jaikumar S. Tumor sound, auditory cues, and tissue pathology in glioma surgery: a proof-of-concept study. J Neurosurg 2023; 139:414-422. [PMID: 36585869 DOI: 10.3171/2022.11.jns222114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/29/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Visual, tactile, and auditory cues are used during surgery to differentiate tissue type. Auditory cues in glioma surgery have not been studied previously. The objectives of this study were 1) to evaluate the feasibility of recording sound generated by the suction device during glioma surgery in matched tissue samples, and 2) to characterize the acoustic variation that occurs in different tissue samples. METHODS This was a prospective observational proof-of-concept study. Recordings were attempted in 20 patients in order meet the accrual target of 10 patients with matched sound and tissue data. For each patient, three 30- to 60-second recordings were made at these sites: normal white matter, infiltrative margin, and tumor. Tissue samples at each site were then reviewed by experienced neuropathologists, and agreement with surgical identification was estimated with the kappa statistic. Acoustic parameters were characterized for each sample. RESULTS Data from 20 patients were analyzed. Patient-related or technical issues resulted in missing data for 10 patients, but the final 10 patients had both audio and tissue data for analysis. Among all tissue samples, fair agreement was observed between surgeon identification and actual pathology (κ = 0.24, standard error 0.096, p = 0.006). Acoustic data suggested that 1) the acoustic stimulus is broadband, 2) acoustic features are somewhat consistent within cases, 3) high-entropy values indicate irregularity of sound over time, and 4) bimodal pitch distributions could differentially reflect cues of interest. CONCLUSIONS This study supports the feasibility of collecting intraoperative data on acoustic features during glioma surgery, and it provides an example of how an analysis could be performed to compare different types of tissues.
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Affiliation(s)
- Michael P Catalino
- Departments of1Neurosurgery
- 5Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | | | - Gregory Chamberlin
- 3Pathology, The University of North Carolina, Chapel Hill
- 6Department of Pathology, Duke University, Durham, North Carolina
| | | | - David Morgan
- 4The University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Madelyn Krebs
- 4The University of North Carolina School of Medicine, Chapel Hill, North Carolina
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17
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Mier-García JF, Ospina-Santa S, Orozco-Mera J, Ma R, Plaha P. Supramaximal versus gross total resection in Glioblastoma, IDH wild-type and Astrocytoma, IDH-mutant, grade 4, effect on overall and progression free survival: systematic review and meta-analysis. J Neurooncol 2023; 164:31-41. [PMID: 37561356 DOI: 10.1007/s11060-023-04409-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To synthesize the evidence on the impact on progression-free survival (PFS) and overall survival (OS) of supramaximal resection (SMR) over gross total resection (GTR) in Glioblastoma, IDH wild-type and Astrocytoma, IDH-mutant, grade 4 (Glioblastoma). METHODS The PubMed, Scopus, Web of Science, Ovid and Cochrane databases were systematically searched (up to November 30, 2022). Studies reporting OS and PFS on adult humans with a suspected Glioblastoma, treated either with a SMR or GTR were included. Hazard ratios were estimated for each study and treatment effects were calculated through DerSimonian and Laird random effects models. RESULTS The literature search yielded 14 studies published between 2013 and 2022, enrolling a total of 6779 patients. Analysis of the included studies reveals significantly better clinical outcomes favoring SMR over GTR in terms of PFS (HR 0.67; p = 0.0007), and OS (HR 0.7; p = 0.0001). CONCLUSION Glioblastoma, IDH wild-type and Astrocytoma, IDH-mutant, grade 4, are aggressive tumors with a very short long-term OS. SMR is an effective therapeutic approach contributing to increased PFS and OS in patients with this catastrophic disease.
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Affiliation(s)
- Juan F Mier-García
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.
- Section of Neurosurgery, School of Medicine, Universidad del Valle, Cali, Valle del Cauca, Colombia.
| | - Stefanía Ospina-Santa
- Department of Neurosurgery, Hospital Universitario del Valle, Cali, Valle del Cauca, Colombia
| | - Javier Orozco-Mera
- Section of Neurosurgery, School of Medicine, Universidad del Valle, Cali, Valle del Cauca, Colombia
- Department of Neurosurgery, Hospital Universitario del Valle, Cali, Valle del Cauca, Colombia
| | - Ruichong Ma
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
- Human Immunology Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
- Nuffield Department of Surgery, University of Oxford, Oxford, Oxfordshire, UK
| | - Puneet Plaha
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
- Nuffield Department of Surgery, University of Oxford, Oxford, Oxfordshire, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
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18
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Peters DR, Halimi F, Ozduman K, Levivier M, Conti A, Reyns N, Tuleasca C. Resection of the contrast-enhancing tumor in diffuse gliomas bordering eloquent areas using electrophysiology and 5-ALA fluorescence: evaluation of resection rates and neurological outcome-a systematic review and meta-analysis. Neurosurg Rev 2023; 46:185. [PMID: 37498398 PMCID: PMC10374773 DOI: 10.1007/s10143-023-02064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023]
Abstract
Independently, both 5-aminolevulinic acid (5-ALA) and intraoperative neuromonitoring (IONM) have been shown to improve outcomes with high-grade gliomas (HGG). The interplay and overlap of both techniques are scarcely reported in the literature. We performed a systematic review and meta-analysis focusing on the concomitant use of 5-ALA and intraoperative mapping for HGG located within eloquent cortex. Using PRISMA guidelines, we reviewed articles published between May 2006 and December 2022 for patients with HGG in eloquent cortex who underwent microsurgical resection using intraoperative mapping and 5-ALA fluorescence guidance. Extent of resection was the primary outcome. The secondary outcome was new neurological deficit at day 1 after surgery and persistent at day 90 after surgery. Overall rate of complete resection of the enhancing tumor (CRET) was 73.3% (range: 61.9-84.8%, p < .001). Complete 5-ALA resection was performed in 62.4% (range: 28.1-96.7%, p < .001). Surgery was stopped due to mapping findings in 20.5% (range: 15.6-25.4%, p < .001). Neurological decline at day 1 after surgery was 29.2% (range: 9.8-48.5%, p = 0.003). Persistent neurological decline at day 90 after surgery was 4.6% (range: 0.4-8.7%, p = 0.03). Maximal safe resection guided by IONM and 5-ALA for high-grade gliomas in eloquent areas is achievable in a high percentage of cases (73.3% CRET and 62.4% complete 5-ALA resection). Persistent neurological decline at postoperative day 90 is as low as 4.6%. A balance between 5-ALA and IONM should be maintained for a better quality of life while maximizing oncological control.
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Affiliation(s)
- David R Peters
- Department of Neurosurgery, Atrium Health, Charlotte, NC, USA.
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Floriana Halimi
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Koray Ozduman
- Department of Neurosurgery, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Marc Levivier
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Alfredo Conti
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- Dipartimento Di Scienze Biomediche E Neuromotorie (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Nicolas Reyns
- Neurosurgery and Neurooncology Service, Centre Hospitalier Regional Universitaire de Lille, Roger Salengro Hospital, Lille, France
| | - Constantin Tuleasca
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Ecole Polytechnique Fédérale de Lausanne (EPFL, LTS-5), Lausanne, Switzerland
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19
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Ordonez-Rubiano EG, Johnson JM, Abdalá-Vargas N, Zorro OF, Marin-Munoz JH, Álvarez-Tobián R, Forlizzi V, Rangel CC, Luzzi S, Campero A, Patiño-Gómez JG, Baldoncini M. Preoperative tractography algorithm for safe resection of tumors located in the descending motor pathways zone. Surg Neurol Int 2023; 14:255. [PMID: 37560574 PMCID: PMC10408624 DOI: 10.25259/sni_230_2023] [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: 03/12/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) tractography facilitates maximal safe resection and optimizes planning to avoid injury during subcortical dissection along descending motor pathways (DMPs). We provide an affordable, safe, and timely algorithm for preoperative DTI motor reconstruction for gliomas adjacent to DMPs. METHODS Preoperative DTI reconstructions were extracted from a prospectively acquired registry of glioma resections adjacent to DMPs. The surgeries were performed over a 7-year period. Demographic, clinical, and radiographic data were extracted from patients' electronic medical records. RESULTS Nineteen patients (12 male) underwent preoperative tractography between January 1, 2013, and May 31, 2020. The average age was 44.5 years (range, 19-81 years). A complete radiological resection was achieved in nine patients, a subtotal resection in five, a partial resection in three, and a biopsy in two. Histopathological diagnoses included 10 patients with high-grade glioma and nine with low-grade glioma. A total of 16 perirolandic locations (10 frontal and six frontoparietal) were recorded, as well as two in the insula and one in the basal ganglia. In 9 patients (47.3%), the lesion was in the dominant hemisphere. The median preoperative and postoperative Karnofsky Performance Scores were 78 and 80, respectively. Motor function was unchanged or improved over time in 15 cases (78.9%). CONCLUSION This protocol of DTI reconstruction for glioma removal near the DMP shows good results in low-term neurological functional outcomes.
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Affiliation(s)
- Edgar G. Ordonez-Rubiano
- Department of Neurosurgery, Hospital de San José - Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
| | - Jason M. Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Nadin Abdalá-Vargas
- Department of Neurological Surgery, Hospital de San José - Sociedad de Cirugía de Bogotá, Colombia
| | - Oscar F. Zorro
- Department of Neurosurgery, Hospital de San José - Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
| | - Jorge H. Marin-Munoz
- Department of Neurosurgery, Hospital de San José - Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
| | - Ricardo Álvarez-Tobián
- Department of Diagnostic Imaging and Diagnostic Radiology, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Valeria Forlizzi
- Department of Anatomy, University of Buenos Aires, Buenos Aires, Argentina
| | - Carlos Castillo Rangel
- Department of Neurosurgery, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Sabino Luzzi
- Department of Neurosurgery, University of Pavia, Pavia, Italy
| | - Alvaro Campero
- Department of Neurosurgery, Hospital Padilla de Tucuman, Tucuman, Argentina
| | - Javier G. Patiño-Gómez
- Department of Neurosurgery, Hospital de San José - Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
| | - Matias Baldoncini
- Department of Neurosurgery, San Fernando Hospital, San Fernando, Argentina
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Jose GRB, Legaspi GD, Ibale MGD, Duñgo ABC. Awake craniotomy: nuts and bolts. Int Anesthesiol Clin 2023; 61:8-12. [PMID: 37243429 DOI: 10.1097/aia.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Geraldine Raphaela B Jose
- Department of Anesthesiology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Gerardo D Legaspi
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Mark Gibson D Ibale
- Department of Anesthesiology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Alec Brandon C Duñgo
- Department of Anesthesiology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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21
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Conway BJ, Taquet L, Boerger TF, Young SC, Krucoff KB, Schmit BD, Krucoff MO. Quantifying Hand Strength and Isometric Pinch Individuation Using a Flexible Pressure Sensor Grid. SENSORS (BASEL, SWITZERLAND) 2023; 23:5924. [PMID: 37447773 DOI: 10.3390/s23135924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023]
Abstract
Modulating force between the thumb and another digit, or isometric pinch individuation, is critical for daily tasks and can be impaired due to central or peripheral nervous system injury. Because surgical and rehabilitative efforts often focus on regaining this dexterous ability, we need to be able to consistently quantify pinch individuation across time and facilities. Currently, a standardized metric for such an assessment does not exist. Therefore, we tested whether we could use a commercially available flexible pressure sensor grid (Tekscan F-Socket [Tekscan Inc., Norwood, MA, USA]) to repeatedly measure isometric pinch individuation and maximum voluntary contraction (MVC) in twenty right-handed healthy volunteers at two visits. We developed a novel equation informed by the prior literature to calculate isometric individuation scores that quantified percentage of force on the grid generated by the indicated digit. MVC intra-class correlation coefficients (ICCs) for the left and right hands were 0.86 (p < 0.0001) and 0.88 (p < 0.0001), respectively, suggesting MVC measurements were consistent over time. However, individuation score ICCs, were poorer (left index ICC 0.41, p = 0.28; right index ICC -0.02, p = 0.51), indicating that this protocol did not provide a sufficiently repeatable individuation assessment. These data support the need to develop novel platforms specifically for repeatable and objective isometric hand dexterity assessments.
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Affiliation(s)
| | - Léon Taquet
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Timothy F Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Sarah C Young
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kate B Krucoff
- Department of Plastic & Reconstructive Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Max O Krucoff
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI 53226, USA
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22
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Ivren M, Grittner U, Khakhar R, Belotti F, Schneider H, Pöser P, D'Agata F, Spena G, Vajkoczy P, Picht T, Rosenstock T. Comparison of anatomical-based vs. nTMS-based risk stratification model for predicting postoperative motor outcome and extent of resection in brain tumor surgery. Neuroimage Clin 2023; 38:103436. [PMID: 37236052 PMCID: PMC10232884 DOI: 10.1016/j.nicl.2023.103436] [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: 11/04/2022] [Revised: 04/07/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Two statistical models have been established to evaluate characteristics associated with postoperative motor outcome in patients with glioma associated to the motor cortex (M1) or the corticospinal tract (CST). One model is based on a clinicoradiological prognostic sum score (PrS) while the other one relies on navigated transcranial magnetic stimulation (nTMS) and diffusion-tensor-imaging (DTI) tractography. The objective was to compare the models regarding their prognostic value for postoperative motor outcome and extent of resection (EOR) with the aim of developing a combined, improved model. METHODS We retrospectively analyzed a consecutive prospective cohort of patients who underwent resection for motor associated glioma between 2008 and 2020, and received a preoperative nTMS motor mapping with nTMS-based diffusion tensor imaging tractography. The primary outcomes were the EOR and the motor outcome (on the day of discharge and 3 months postoperatively according to the British Medical Research Council (BMRC) grading). For the nTMS model, the infiltration of M1, tumor-tract distance (TTD), resting motor threshold (RMT) and fractional anisotropy (FA) were assesed. For the PrS score (ranging from 1 to 8, lower scores indicating a higher risk), we assessed tumor margins, volume, presence of cysts, contrast agent enhancement, MRI index (grading white matter infiltration), preoperative seizures or sensorimotor deficits. RESULTS Two hundred and three patients with a median age of 50 years (range: 20-81 years) were analyzed of whom 145 patients (71.4%) received a GTR. The rate of transient new motor deficits was 24.1% and of permanent new motor deficits 18.8%. The nTMS model demonstrated a good discrimination ability for the short-term motor outcome at day 7 of discharge (AUC = 0.79, 95 %CI: 0.72-0.86) and the long-term motor outcome after 3 months (AUC = 0.79, 95 %CI: 0.71-0.87). The PrS score was not capable to predict the postoperative motor outcome in this cohort but was moderately associated with the EOR (AUC = 0.64; CI 0.55-0.72). An improved, combined model was calculated to predict the EOR more accurately (AUC = 0.74, 95 %CI: 0.65-0.83). CONCLUSION The nTMS model was superior to the clinicoradiological PrS model for potentially predicting the motor outcome. A combined, improved model was calculated to estimate the EOR. Thus, patient counseling and surgical planning in patients with motor-associated tumors should be performed using functional nTMS data combined with tractography.
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Affiliation(s)
- Meltem Ivren
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Rutvik Khakhar
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Francesco Belotti
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; Neurosurgery Unit, Spedali Civili di Brescia Hospital, 25123 Brescia, Italy
| | - Heike Schneider
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Paul Pöser
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Federico D'Agata
- Department of Neuroscience, University of Turin, Via Verdi 8, 10124 Turin, Italy
| | - Giannantonio Spena
- Neurosurgery Unit, Spedali Civili di Brescia Hospital, 25123 Brescia, Italy
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Thomas Picht
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Unter den Linden 6, 10099 Berlin, Germany
| | - Tizian Rosenstock
- Department of Neurosurgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program, Charitéplatz 1, 10117 Berlin, Germany.
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23
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Conway BJ, Taquet L, Boerger TF, Young SC, Krucoff KB, Schmit BD, Krucoff MO. Quantitative assessments of finger individuation with an instrumented glove. J Neuroeng Rehabil 2023; 20:48. [PMID: 37081513 PMCID: PMC10120262 DOI: 10.1186/s12984-023-01173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND In clinical and research settings, hand dexterity is often assessed as finger individuation, or the ability to move one finger at a time. Despite its clinical importance, there is currently no standardized, sufficiently sensitive, or fully objective platform for these evaluations. METHODS Here we developed two novel individuation scores and tested them against a previously developed score using a commercially available instrumented glove and data collected from 20 healthy adults. Participants performed individuation for each finger of each hand as well as whole hand open-close at two study visits separated by several weeks. Using the three individuation scores, intra-class correlation coefficients (ICC) and minimal detectable changes (MDC) were calculated. Individuation scores were further correlated with subjective assessments to assess validity. RESULTS We found that each score emphasized different aspects of individuation performance while generating scores on the same scale (0 [poor] to 1 [ideal]). These scores were repeatable, but the quality of the metrics varied by both equation and finger of interest. For example, index finger intra-class correlation coefficients (ICC's) were 0.90 (< 0.0001), 0.77 (< 0.001), and 0.83 (p < 0.0001), while pinky finger ICC's were 0.96 (p < 0.0001), 0.88 (p < 0.0001), and 0.81 (p < 0.001) for each score. Similarly, MDCs also varied by both finger and equation. In particular, thumb MDCs were 0.068, 0.14, and 0.045, while index MDCs were 0.041, 0.066, and 0.078. Furthermore, objective measurements correlated with subjective assessments of finger individuation quality for all three equations (ρ = - 0.45, p < 0.0001; ρ = - 0.53, p < 0.0001; ρ = - 0.40, p < 0.0001). CONCLUSIONS Here we provide a set of normative values for three separate finger individuation scores in healthy adults with a commercially available instrumented glove. Each score emphasizes a different aspect of finger individuation performance and may be more uniquely applicable to certain clinical scenarios. We hope for this platform to be used within and across centers wishing to share objective data in the physiological study of hand dexterity. In sum, this work represents the first healthy participant data set for this platform and may inform future translational applications into motor physiology and rehabilitation labs, orthopedic hand and neurosurgery clinics, and even operating rooms.
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Affiliation(s)
- Brian J Conway
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Léon Taquet
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Timothy F Boerger
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sarah C Young
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kate B Krucoff
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Max O Krucoff
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, USA
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24
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Al-Adli NN, Young JS, Sibih YE, Berger MS. Technical Aspects of Motor and Language Mapping in Glioma Patients. Cancers (Basel) 2023; 15:cancers15072173. [PMID: 37046834 PMCID: PMC10093517 DOI: 10.3390/cancers15072173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023] Open
Abstract
Gliomas are infiltrative primary brain tumors that often invade functional cortical and subcortical regions, and they mandate individualized brain mapping strategies to avoid postoperative neurological deficits. It is well known that maximal safe resection significantly improves survival, while postoperative deficits minimize the benefits associated with aggressive resections and diminish patients’ quality of life. Although non-invasive imaging tools serve as useful adjuncts, intraoperative stimulation mapping (ISM) is the gold standard for identifying functional cortical and subcortical regions and minimizing morbidity during these challenging resections. Current mapping methods rely on the use of low-frequency and high-frequency stimulation, delivered with monopolar or bipolar probes either directly to the cortical surface or to the subcortical white matter structures. Stimulation effects can be monitored through patient responses during awake mapping procedures and/or with motor-evoked and somatosensory-evoked potentials in patients who are asleep. Depending on the patient’s preoperative status and tumor location and size, neurosurgeons may choose to employ these mapping methods during awake or asleep craniotomies, both of which have their own benefits and challenges. Regardless of which method is used, the goal of intraoperative stimulation is to identify areas of non-functional tissue that can be safely removed to facilitate an approach trajectory to the equator, or center, of the tumor. Recent technological advances have improved ISM’s utility in identifying subcortical structures and minimized the seizure risk associated with cortical stimulation. In this review, we summarize the salient technical aspects of which neurosurgeons should be aware in order to implement intraoperative stimulation mapping effectively and safely during glioma surgery.
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Affiliation(s)
- Nadeem N. Al-Adli
- Department of Neurological Surgery, University of California, San Francisco, CA 94131, USA
- School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Jacob S. Young
- Department of Neurological Surgery, University of California, San Francisco, CA 94131, USA
| | - Youssef E. Sibih
- School of Medicine, University of California, San Francisco, CA 94131, USA
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, CA 94131, USA
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25
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Sahrizan NSA, Manan HA, Abdul Hamid H, Abdullah JM, Yahya N. Functional Alteration in the Brain Due to Tumour Invasion in Paediatric Patients: A Systematic Review. Cancers (Basel) 2023; 15:cancers15072168. [PMID: 37046828 PMCID: PMC10093754 DOI: 10.3390/cancers15072168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
Working memory, language and speech abilities, motor skills, and visual abilities are often impaired in children with brain tumours. This is because tumours can invade the brain's functional areas and cause alterations to the neuronal networks. However, it is unclear what the mechanism of tumour invasion is and how various treatments can cause cognitive impairment. Therefore, this study aims to systematically evaluate the effects of tumour invasion on the cognitive, language, motor, and visual abilities of paediatric patients, as well as discuss the alterations and modifications in neuronal networks and anatomy. The electronic database, PubMed, was used to find relevant studies. The studies were systematically reviewed based on the type and location of brain tumours, cognitive assessment, and pre- and post-operative deficits experienced by patients. Sixteen studies were selected based on the inclusion and exclusion criteria following the guidelines from PRISMA. Most studies agree that tumour invasion in the brain causes cognitive dysfunction and alteration in patients. The effects of a tumour on cognition, language, motor, and visual abilities depend on the type of tumour and its location in the brain. The alteration to the neuronal networks is also dependent on the type and location of the tumour. However, the default mode network (DMN) is the most affected network, regardless of the tumour type and location.Furthermore, our findings suggest that different treatment types can also contribute to patients' cognitive function to improve or deteriorate. Deficits that persisted or were acquired after surgery could result from surgical manipulation or the progression of the tumour's growth. Meanwhile, recovery from the deficits indicated that the brain has the ability to recover and reorganise itself.
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Affiliation(s)
- Nur Shaheera Aidilla Sahrizan
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Hanani Abdul Manan
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Hamzaini Abdul Hamid
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Jafri Malin Abdullah
- Jabatan Neurosains, Pusat Pengajian Sains Perubatan, Jalan Hospital USM, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Brain and Behaviour Cluster, Pusat Pengajian Sains Perubatan, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Department of Neurosciences & Brain Behaviour Cluster, Hospital Universiti Sains Malaysia, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, School of Diagnostic & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
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Wach J, Vychopen M, Kühnapfel A, Seidel C, Güresir E. A Systematic Review and Meta-Analysis of Supramarginal Resection versus Gross Total Resection in Glioblastoma: Can We Enhance Progression-Free Survival Time and Preserve Postoperative Safety? Cancers (Basel) 2023; 15:cancers15061772. [PMID: 36980659 PMCID: PMC10046815 DOI: 10.3390/cancers15061772] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
To date, gross total resection (GTR) of the contrast-enhancing area of glioblastoma (GB) is the benchmark treatment regarding surgical therapy. However, GB infiltrates beyond those margins, and most tumors recur in close proximity to the initial resection margin. It is unclear whether a supramarginal resection (SMR) enhances progression-free survival (PFS) time without increasing the incidence of postoperative surgical complications. The aim of the present meta-analysis was to investigate SMR with regard to PFS and postoperative surgical complications. We searched for eligible studies comparing SMR techniques with conventional GTR in PubMed, Cochrane Library, Web of Science, and Medline databases. From 3158 initially identified records, 11 articles met the criteria and were included in our meta-analysis. Our results illustrate significantly prolonged PFS time in SMR compared with GTR (HR: 11.16; 95% CI: 3.07–40.52, p = 0.0002). The median PFS of the SMR arm was 8.44 months (95% CI: 5.18–11.70, p < 0.00001) longer than the GTR arm. The rate of postoperative surgical complications (meningitis, intracranial hemorrhage, and CSF leaks) did not differ between the SMR group and the GTR group. SMR resulted in longer median progression-free survival without a negative postoperative surgical risk profile. Multicentric prospective randomized trials with a standardized definition of SMR and analysis of neurologic functioning and health-related quality of life are justified and needed to improve the level of evidence.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany
- Correspondence:
| | - Martin Vychopen
- Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Andreas Kühnapfel
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, 04107 Leipzig, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany
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27
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Jusue-Torres I, Lee J, Germanwala AV, Burns TC, Parney IF. Effect of Extent of Resection on Survival of Patients with Glioblastoma, IDH-Wild-Type, WHO Grade 4 (WHO 2021): Systematic Review and Meta-Analysis. World Neurosurg 2023; 171:e524-e532. [PMID: 36529434 PMCID: PMC10030177 DOI: 10.1016/j.wneu.2022.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In light of the recently updated World Health Organization (WHO) 2021 central nervous system tumor classifications, the aim of the present study was to establish the effect of the resection extent on overall survival (OS) and progression-free survival (PFS) for patients who met the current diagnostic criteria for glioblastoma, isocitrate dehydrogenase (IDH)-wild-type (WT), WHO grade 4. METHODS A systematic literature search was performed using the following databases: PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews and ClinicalTrials.gov to identify studies that had compared OS and PFS after gross total resection (GTR) versus subtotal resection (STR) or biopsy for glioblastoma IDH-WT. RESULTS We identified 1439 studies, of which 9 met the inclusion and/or exclusion criteria. Of the 2023 patients, 788 had undergone GTR. The meta-analysis showed a significant increase in the OS and PFS duration after GTR for glioblastoma IDH-WT, with a median OS of 20 months (95% confidence interval [CI], 17-25) after GTR versus 12 months (95% CI, 9-15) after STR (P < 0.0001). The median PFS was 11 months (95% CI, 9-12) after GTR versus 7 months (95% CI, 5-7) after STR (P < 0.0001). GTR was associated with a 51% reduction in the mortality risk (hazard ratio, 0.49; 95% CI, 0.36-0.65) and a 42% reduction in the progression risk (hazard ratio, 0.58; 95% CI, 0.39-0.88) compared with STR. CONCLUSIONS The results from our systematic review suggest that GTR is associated with improved OS and PFS compared with STR for glioblastoma, IDH-WT, WHO grade 4 (WHO 2021). However, our findings were limited by the various study designs and significant clinical and methodologic heterogeneity among the studies.
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Affiliation(s)
| | - Jonathan Lee
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Anand V Germanwala
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, USA; Department of Otolaryngology, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Terry C Burns
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian F Parney
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Giambra M, Di Cristofori A, Valtorta S, Manfrellotti R, Bigiogera V, Basso G, Moresco RM, Giussani C, Bentivegna A. The peritumoral brain zone in glioblastoma: where we are and where we are going. J Neurosci Res 2023; 101:199-216. [PMID: 36300592 PMCID: PMC10091804 DOI: 10.1002/jnr.25134] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/01/2022] [Accepted: 10/01/2022] [Indexed: 12/13/2022]
Abstract
Glioblastoma (GBM) is the most aggressive and invasive primary brain tumor. Current therapies are not curative, and patients' outcomes remain poor with an overall survival of 20.9 months after surgery. The typical growing pattern of GBM develops by infiltrating the surrounding apparent normal brain tissue within which the recurrence is expected to appear in the majority of cases. Thus, in the last decades, an increased interest has developed to investigate the cellular and molecular interactions between GBM and the peritumoral brain zone (PBZ) bordering the tumor tissue. The aim of this review is to provide up-to-date knowledge about the oncogenic properties of the PBZ to highlight possible druggable targets for more effective treatment of GBM by limiting the formation of recurrence, which is almost inevitable in the majority of patients. Starting from the description of the cellular components, passing through the illustration of the molecular profiles, we finally focused on more clinical aspects, represented by imaging and radiological details. The complete picture that emerges from this review could provide new input for future investigations aimed at identifying new effective strategies to eradicate this still incurable tumor.
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Affiliation(s)
- Martina Giambra
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,PhD Program in Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Andrea Di Cristofori
- PhD Program in Neuroscience, University of Milano-Bicocca, Monza, Italy.,Division of Neurosurgery, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza, Italy
| | - Silvia Valtorta
- Department of Nuclear Medicine, San Raffaele Scientific Institute, IRCCS, Milan, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Segrate, Italy.,NBFC, National Biodiversity Future Center, 90133, Palermo, Italy
| | - Roberto Manfrellotti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Division of Neurosurgery, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza, Italy
| | - Vittorio Bigiogera
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Gianpaolo Basso
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Rosa Maria Moresco
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Nuclear Medicine, San Raffaele Scientific Institute, IRCCS, Milan, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Segrate, Italy
| | - Carlo Giussani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Division of Neurosurgery, Azienda Socio Sanitaria Territoriale - Monza, Ospedale San Gerardo, Monza, Italy
| | - Angela Bentivegna
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Lavalle L, D'Elia A, Ciavarro M, Esposito V. Subpial technique in supratentorial glioma resection: state of the art and analysis of costs and effectiveness in a single institute experience. J Neurosurg Sci 2023; 67:73-82. [PMID: 32989970 DOI: 10.23736/s0390-5616.20.05046-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many neurosurgeons advocate subpial technique as the best technique to remove supratentorial gliomas. However, few authors clearly defined advantages and features of this technique. The aim of our study is to describe microsurgical subpial technique related to glioma surgery, with regard to its safety and cost effectiveness. METHODS We analyzed retrospectively all consecutive patients surgically treated for supratentorial glioma from January 2017 to April 2018 at Neurosurgery Department of Neuromed Institute. All patients underwent to surgical glioma resection performing microsurgical subpial technique. Extent of resection and neurological complications were evaluated as primary outcomes; Karnofsky Performance Status and postoperative edema extent were secondary outcomes. Statistical analysis was obtained. RESULTS The study included 70 patients. Gross Total Removal was obtained in 91.3% of patients with low grade glioma (LGG) and in 81% of patients with high grade glioma. Neurological complications amounted to 34% at early assessment in LGG patients, which were permanent at 3 months in 17% of patients. In high grade glioma patients, neurological complications amounted to 51% at early assessment, which were permanent at 3 months in 25% of them. CONCLUSIONS We obtained good postoperative results with regard to the extent of tumor resection using this technique. Subpial resection is an effective surgical technique to get a safer and more complete tumor resection. It should be combined with other modern neurosurgical tools such as neuronavigation, ultrasound and cortical mapping to obtain the best tumor resection and functional neurological preservation.
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Affiliation(s)
- Laura Lavalle
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Isernia, Italy -
| | - Alessandro D'Elia
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Marco Ciavarro
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Vincenzo Esposito
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Isernia, Italy
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Belyaev AY, Kobyakov GL, Shmakov PN, Efremov KV, Pronin IN, Usachev DY. [Prognosis of overall and disease-free survival in patients with grade 3 astrocytomas (anaplastic astrocytoma, WHO 2016)]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:46-57. [PMID: 37650276 DOI: 10.17116/neiro20238704146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Anaplastic astrocytoma (AA) is a rare intracerebral tumor. Therefore, the number of studies devoted to risk factors of overall and disease-free survival is small. This single-center clinical study is devoted to various factors influencing prognosis of treatment in this group of patients. MATERIAL AND METHODS A retrospective study included 389 patients diagnosed with grade 3 astrocytoma. We analyzed dependence of overall and disease-free survival from the following factors: gender, age of onset of disease, tumor extent, surgery, neurological disorders before and after surgery (NANO grading system), Ki67 index, postoperative radio- and chemotherapy (number courses, treatment regimens). RESULTS Significant risk factors for overall and disease-free survival were spread and volume of tumor, postoperative neurological aggravation, Ki67 index, IDH mutation, radio- and chemotherapy. Age, frontal lobe tumor and disease manifestation variant were significant only for overall, but not for disease-free survival. CONCLUSION This study was based on material of one of the largest clinical series of patients with AA operated on in one center in «molecular» era. Our results are consistent with previous data. Analysis of tumor biology and risk factors for IDH-negative AA without molecular signs of glioblastoma may be perspective.
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Affiliation(s)
| | | | - P N Shmakov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - K V Efremov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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Kobyletskaya TM, Chuguev AS, Zaytsev AM, Kaprin AD, Datsenko PV. [Extent of resection in patients with glioblastoma]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:63-68. [PMID: 37830470 DOI: 10.17116/neiro20238705163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To investigate the impact of resection quality on subsequent survival of patients with glioblastoma. MATERIAL AND METHODS There were 141 patients with morphologically confirmed glioblastoma (grade 4). Fractionation with the prescribed dose of 2 and 3 Gy was alternately used (pairwise modeling strategy). Total resection was performed in 29.8% of patients (EOR: 100%; n=42), subtotal - 56.7% (EOR: 70-99%; n=80). Extent of resection 1-69% was registered in 19 patients (13.5%). RESULTS As of December 2022, 124 out of 141 patients (87.9%) were diagnosed with primary progression, 101 (71.6%) ones died. We analyzed the threshold role of EOR. The most informative level was 70% (p=0.002). EOR 100% was followed by median overall survival about 32.2 months (95% Cl: 15.3-49.1), EOR 70-99% - 21.3 months (95% Cl: 15.1-27.5), EOR 1-69% - 10.3 months (95% Cl: 3.8-16.9; p=0.003). Fractionation mode with the prescribed dose of 3 Gy partially eliminated significance of EOR (p=0.148) in contrast to standard fractionation (p=0.015). Tumor growth in the interval between surgery and radiotherapy (REP) reduces significance of EOR (p=0.042). Inclusion of second-line therapy with bevacizumab in multivariate analysis model (OR=0.488; p=0.002) makes EOR less significant (OR=0.749; p=0.085) in contrast to REP (OR=2.482; p<0.0001). CONCLUSION To date, the principle of maximum safe resection remains fundamental in neurosurgery. EOR about 70% is sufficient regarding overall survival, but total resection should be sought if possible.
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Affiliation(s)
| | - A S Chuguev
- Herzen Moscow Oncology Research Institute, Moscow, Russia
| | - A M Zaytsev
- Herzen Moscow Oncology Research Institute, Moscow, Russia
| | - A D Kaprin
- Herzen Moscow Oncology Research Institute, Moscow, Russia
| | - P V Datsenko
- Herzen Moscow Oncology Research Institute, Moscow, Russia
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Risk factors and prognostic implications of surgery-related strokes following resection of high-grade glioma. Sci Rep 2022; 12:22594. [PMID: 36585482 PMCID: PMC9803666 DOI: 10.1038/s41598-022-27127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
Surgery-related strokes are an important cause of morbidity following resection of high-grade glioma (HGG). We explored the incidence, risk factors and clinical consequences of intra-operative ischemic strokes in surgeries for resection of HGG. We retrospectively followed a cohort of 239 patients who underwent surgical resection of HGG between 2013 and 2017. Tumor types included both isocitrate dehydrogenase (IDH) wildtype glioblastoma and IDH-mutant WHO grade 4 astrocytoma. We analyzed pre- and post-operative demographic, clinical, radiological, anesthesiology and intraoperative neurophysiology data, including overall survival and functional outcomes. Acute ischemic strokes were seen on postoperative diffusion-weighted imaging (DWI) in 30 patients (12.5%), 13 of whom (43%) developed new neurological deficits. Infarcts were more common in insular (23%, p = 0.019) and temporal surgeries (57%, p = 0.01). Immediately after surgery, 35% of patients without infarcts and 57% of those with infarcts experienced motor deficits (p = 0.022). Six months later, rates of motor deficits decreased to 25% in the non-infarcts group and 37% in the infarcts group (p = 0.023 and 0.105, respectively) with a significantly lower Karnofsky-Performance Score (KPS, p = 0.001). Intra-operative language decline in awake procedures was a significant indicator of the occurrence of intra-operative stroke (p = 0.029). In conclusion, intraoperative ischemic events are more common in insular and temporal surgeries for resection of HGG and their intra-operative detection is limited. These strokes can impair motor and speech functions as well as patients' performance status.
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Kim AA, Dono A, Khalafallah AM, Nettel-Rueda B, Samandouras G, Hadjipanayis CG, Mukherjee D, Esquenazi Y. Early repeat resection for residual glioblastoma: decision-making among an international cohort of neurosurgeons. J Neurosurg 2022; 137:1618-1627. [PMID: 35364590 PMCID: PMC10972535 DOI: 10.3171/2022.1.jns211970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The importance of extent of resection (EOR) in glioblastoma (GBM) has been thoroughly demonstrated. However, few studies have explored the practices and benefits of early repeat resection (ERR) when residual tumor deemed resectable is unintentionally left after an initial resection, and the survival benefit of ERR is still unknown. Herein, the authors aimed to internationally survey current practices regarding ERR and to analyze differences based on geographic location and practice setting. METHODS The authors distributed a survey to the American Association of Neurological Surgeons and Congress of Neurological Surgeons Tumor Section, Society of British Neurological Surgeons, European Association of Neurosurgical Society, and Latin American Federation of Neurosurgical Societies. Neurosurgeons responded to questions about their training, practice setting, and current ERR practices. They also reported the EOR threshold below which they would pursue ERR and their likelihood of performing ERR using a Likert scale of 1-5 (5 being the most likely) in two sets of 5 cases, the first set for a patient's initial hospitalization and the second for a referred patient who had undergone resection elsewhere. The resection likelihood index for each respondent was calculated as the mean Likert score across all cases. RESULTS Overall, 180 neurosurgeons from 25 countries responded to the survey. Neurosurgeons performed ERRs very rarely in their practices (< 1% of all GBM cases), with an EOR threshold of 80.2% (75%-95%). When presented with 10 cases, the case context (initial hospitalization vs referred patient) did not significantly change the surgeon ERR likelihood, although ERR likelihood did vary significantly on the basis of tumor location (p < 0.0001). Latin American neurosurgeons were more likely to pursue ERR in the provided cases. Neurosurgeons were more likely to pursue ERR when the tumor was MGMT methylated versus unmethylated, with a resection likelihood index of 3.78 and 3.21, respectively (p = 0.004); however, there was no significant difference between IDH mutant and IDH wild-type tumors. CONCLUSIONS Results of this survey reveal current practices regarding ERR, but they also demonstrate the variability in how neurosurgeons approach ERR. Standardized guidelines based on future studies incorporating tumor molecular characteristics are needed to guide neurosurgeons in their decision-making on this complicated issue.
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Affiliation(s)
- Anya A. Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas
| | - Adham M. Khalafallah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara Nettel-Rueda
- Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexican Social Security Institute, México City, México
| | - George Samandouras
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Constantinos G. Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Texas
- Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Texas
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What surgical approach for left-sided eloquent glioblastoma: biopsy, resection under general anesthesia or awake craniotomy? J Neurooncol 2022; 160:445-454. [DOI: 10.1007/s11060-022-04163-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
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Suarez-Meade P, Marenco-Hillembrand L, Sabsevitz D, Okromelidze L, Blake Perdikis B, Sherman WJ, Quinones-Hinojosa A, Middlebrooks EH, Chaichana KL. Surgical Resection of Gliomas in the Dominant Inferior Frontal Gyrus: Consecutive Case Series and Anatomy Review of Broca’s Area. Clin Neurol Neurosurg 2022; 223:107512. [DOI: 10.1016/j.clineuro.2022.107512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
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Löfgren D, Valachis A, Olivecrona M. Risk for morbidity and mortality after neurosurgery in older patients with high grade gliomas - a retrospective population based study. BMC Geriatr 2022; 22:805. [PMID: 36253725 PMCID: PMC9575213 DOI: 10.1186/s12877-022-03478-6] [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: 01/05/2022] [Accepted: 09/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Although high grade gliomas largely affect older patients, current evidence on neurosurgical complications is mostly based on studies including younger study populations. We aimed to investigate the risk for postoperative complications after neurosurgery in a population-based cohort of older patients with high grade gliomas, and explore changes over time. Methods In this retrospective study we have used data from the Swedish Brain Tumour Registry and included patients in Sweden age 65 years or older, with surgery 1999–2017 for high grade gliomas. We analysed number of surgical procedures per year and which factors contribute to postoperative morbidity and mortality. Results The study included 1998 surgical interventions from an area representing 60% of the Swedish population. Over time, there was an increase in surgical interventions in relation to the age specific population (p < 0.001). Postoperative morbidity for 2006–2017 was 24%. Resection and not having a multifocal tumour were associated with higher risk for postoperative morbidity. Postoperative mortality for the same period was 5%. Increased age, biopsy, and poor performance status was associated with higher risk for postoperative mortality. Conclusions This study shows an increase in surgical interventions over time, probably representing a more active treatment approach. The relatively low postoperative morbidity- and mortality-rates suggests that surgery in older patients with suspected high grade gliomas can be a feasible option. However, caution is advised in patients with poor performance status where the possible surgical intervention would be a biopsy only. Further, this study underlines the need for more standardised methods of reporting neurosurgical complications. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03478-6.
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Affiliation(s)
- David Löfgren
- Department of Oncology, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden.
| | - Antonios Valachis
- Department of Oncology, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden
| | - Magnus Olivecrona
- Department of Neurosurgery, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden
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Krajewski S, Furtak J, Zawadka-Kunikowska M, Kachelski M, Birski M, Harat M. Rehabilitation Outcomes for Patients with Motor Deficits after Initial and Repeat Brain Tumor Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10871. [PMID: 36078585 PMCID: PMC9518489 DOI: 10.3390/ijerph191710871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 05/31/2023]
Abstract
Repeat surgery is often required to treat brain tumor recurrences. Here, we compared the functional state and rehabilitation of patients undergoing initial and repeat surgery for brain tumors to establish their individual risks that might impact management. In total, 835 patients underwent operations, and 139 (16.6%) required rehabilitation during the inpatient stay. The Karnofsky performance status, Barthel index, and the modified Rankin scale were used to assess functional status, and the gait index was used to assess gait efficiency. Motor skills, postoperative complications, and length of hospital stay were recorded. Patients were classified into two groups: first surgery (n = 103) and repeat surgery (n = 30). Eighteen percent of patients required reoperations, and these patients required prolonged postoperative rehabilitation as often as those operated on for the first time. Rehabilitation was more often complicated in the repeat surgery group (p = 0.047), and the complications were more severe and persistent. Reoperated patients had significantly worse motor function and independence in activities of daily living before surgery and at discharge, but the deterioration after surgery affected patients in the first surgery group to a greater extent according to all metrics (p < 0.001). The length of hospital stay was similar in both groups. These results will be useful for tailoring postoperative rehabilitation during a hospital stay on the neurosurgical ward as well as planning discharge requirements after leaving the hospital.
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Affiliation(s)
- Stanisław Krajewski
- Department of Physiotherapy, University of Bydgoszcz, Unii Lubelskiej 4, 85-059 Bydgoszcz, Poland
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
| | - Jacek Furtak
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
- Department of Neurooncology and Radiosurgery, Franciszek Łukaszczyk Oncology Center, 85-796 Bydgoszcz, Poland
| | - Monika Zawadka-Kunikowska
- Department of Human Physiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Karłowicza 24, 85-092 Bydgoszcz, Poland
| | - Michał Kachelski
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
| | - Marcin Birski
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
| | - Marek Harat
- Department of Neurosurgery, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
- Department of Neurosurgery and Neurology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
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Hatoum R, Chen JS, Lavergne P, Shlobin NA, Wang A, Elkaim LM, Dodin P, Couturier CP, Ibrahim GM, Fallah A, Venne D, Perreault S, Wang AC, Jabado N, Dudley RWR, Weil AG. Extent of Tumor Resection and Survival in Pediatric Patients With High-Grade Gliomas: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2226551. [PMID: 35972743 PMCID: PMC9382445 DOI: 10.1001/jamanetworkopen.2022.26551] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE Pediatric patients with high-grade gliomas have a poor prognosis. The association among the extent of resection, tumor location, and survival in these patients remains unclear. OBJECTIVE To ascertain whether gross total resection (GTR) in hemispheric, midline, or infratentorial pediatric high-grade gliomas (pHGGs) is independently associated with survival differences compared with subtotal resection (STR) and biopsy at 1 year and 2 years after tumor resection. DATA SOURCES PubMed, EBMR, Embase, and MEDLINE were systematically reviewed from inception to June 3, 2022, using the keywords high-grade glioma, pediatric, and surgery. No period or language restrictions were applied. STUDY SELECTION Randomized clinical trials and cohort studies of pHGGs that stratified patients by extent of resection and reported postoperative survival were included for study-level and individual patient data meta-analyses. DATA EXTRACTION AND SYNTHESIS Study characteristics and mortality rates were extracted from each article. Relative risk ratios (RRs) were pooled using random-effects models. Individual patient data were evaluated using multivariate mixed-effects Cox proportional hazards regression modeling. The PRISMA reporting guideline was followed, and the study was registered a priori. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) and RRs were extracted to indicate associations among extent of resection, 1-year and 2-year postoperative mortality, and overall survival. RESULTS A total of 37 studies with 1387 unique patients with pHGGs were included. In study-level meta-analysis, GTR had a lower mortality risk than STR at 1 year (RR, 0.69; 95% CI, 0.56-0.83; P < .001) and 2 years (RR, 0.74; 95% CI, 0.67-0.83; P < .001) after tumor resection. Subtotal resection was not associated with differential survival compared with biopsy at 1 year (RR, 0.82; 95% CI, 0.66-1.01; P = .07) but had decreased mortality risk at 2 years (RR, 0.89; 95% CI, 0.82-0.97; P = .01). The individual patient data meta-analysis of 27 articles included 427 patients (mean [SD] age at diagnosis, 9.3 [5.9] years), most of whom were boys (169 of 317 [53.3%]), had grade IV tumors (246 of 427 [57.7%]), and/or had tumors that were localized to either the cerebral hemispheres (133 of 349 [38.1%]) or midline structures (132 of 349 [37.8%]). In the multivariate Cox proportional hazards regression model, STR (HR, 1.91; 95% CI, 1.34-2.74; P < .001) and biopsy (HR, 2.10; 95% CI, 1.43-3.07; P < .001) had shortened overall survival compared with GTR but no survival differences between them (HR, 0.91; 95% CI, 0.67-1.24; P = .56). Gross total resection was associated with prolonged survival compared with STR for hemispheric (HR, 0.29; 95% CI, 0.15-0.54; P < .001) and infratentorial (HR, 0.44; 95% CI, 0.24-0.83; P = .01) tumors but not midline tumors (HR, 0.63; 95% CI, 0.34-1.19; P = .16). CONCLUSIONS AND RELEVANCE Results of this study show that, among patients with pHGG, GTR is independently associated with better overall survival compared with STR and biopsy, especially among patients with hemispheric and infratentorial tumors, and support the pursuit of maximal safe resection in the treatment of pHGGs.
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Affiliation(s)
- Rami Hatoum
- University of Montréal School of Medicine, Montréal, Quebec, Canada
| | - Jia-Shu Chen
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Pascal Lavergne
- Department of Neurological Surgery, University of Washington, Seattle
| | - Nathan A. Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew Wang
- Department of Neurosurgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Lior M. Elkaim
- Division of Neurology and Neurosurgery, McGill University, McGill University Health Center, Montreal, Quebec, Canada
| | - Philippe Dodin
- Medical Library, Centre Hospitalier Universitaire (CHU) Sainte-Justine Children’s, Montréal, Quebec, Canada
| | - Charles P. Couturier
- Department of Neurology and Neurosurgery, Montréal Neurological Institute–Hospital, Montréal, Quebec, Canada
| | - George M. Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Aria Fallah
- Department of Neurosurgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
- Department of Pediatrics, David Geffen School of Medicine at UCLA
| | - Dominic Venne
- Division of Neurosurgery, Ste Justine Hospital, University of Montréal, Montréal, Quebec, Canada
| | | | - Anthony C. Wang
- Department of Neurosurgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
- Department of Pediatrics, David Geffen School of Medicine at UCLA
| | - Nada Jabado
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada
- Department of Pediatrics, McGill University and McGill University Health Centre Research Institute, Montréal, Quebec, Canada
| | - Roy W. R. Dudley
- Neurosurgery Service, Department of Surgery, McGill University and McGill University Health Centre Research Institute, Montréal, Quebec, Canada
| | - Alexander G. Weil
- Division of Neurosurgery, Ste Justine Hospital, University of Montréal, Montréal, Quebec, Canada
- Neurosurgery Service, Department of Surgery, University of Montreal Hospital Center, Montréal, Quebec, Canada
- Sainte-Justine University Hospital Research Center, Montréal, Quebec, Canada
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A consensus definition of supratotal resection for anatomically distinct primary glioblastoma: an AANS/CNS Section on Tumors survey of neurosurgical oncologists. J Neurooncol 2022; 159:233-242. [PMID: 35913556 DOI: 10.1007/s11060-022-04048-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/26/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Supratotal resection (SpTR) of glioblastoma may be associated with improved survival, but published results have varied in part from lack of consensus on the definition and appropriate use of SpTR. A previous small survey of neurosurgical oncologists with expertise performing SpTR found resection 1-2 cm beyond contrast enhancement was an acceptable definition and glioblastoma involving the right frontal and bilateral anterior temporal lobes were considered most amenable to SpTR. The general neurosurgical oncology community has not yet confirmed the practicality of this definition. METHODS Seventy-six neurosurgical oncology members of the AANS/CNS Tumor Section were surveyed, representing 34.0% of the 223 members who were administered the survey. Participants were presented with 11 definitions of SpTR and rated each definition's appropriateness. Participants additionally reviewed magnetic resonance imaging for 10 anatomically distinct glioblastomas and assessed the tumor location's eloquence, perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans. RESULTS Most neurosurgeons surveyed agree that gross total plus resection of some non-contrast enhancement (n = 57, 80.3%) or resection 1-2 cm beyond contrast enhancement (n = 52, 73.2%) are appropriate definitions for SpTR. Cases were divided into three anatomically distinct groups by perceived equipoise between gross total and SpTR. The best clinical trial candidates were thought to be right anterior temporal (n = 58, 76.3%) and right frontal (n = 55, 73.3%) glioblastomas. CONCLUSION Support exists among neurosurgical oncologists with varying familiarity performing SpTR to adopt the proposed consensus definition of SpTR of glioblastoma and to potentially investigate the utility of SpTR to treat right anterior temporal and right frontal glioblastomas in a clinical trial. A smaller proportion of general neurosurgical oncologists than SpTR experts would personally treat a left anterior temporal glioblastoma with SpTR.
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Berger A, Tzarfati GG, Serafimova M, Valdes P, Meller A, Korn A, Levy NK, Aviram D, Ram Z, Grossman R. Clinical and prognostic implications of rim restriction following glioma surgery. Sci Rep 2022; 12:12874. [PMID: 35896589 PMCID: PMC9329326 DOI: 10.1038/s41598-022-16717-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Rim restriction surrounding the resection cavity of glioma is often seen on immediate post-op diffusion-weighted imaging (DWI). The etiology and clinical impact of rim restriction are unknown. We evaluated the incidence, risk factors and clinical consequences of this finding. We evaluated patients that underwent surgery for low-grade glioma (LGG) and glioblastoma (GBM) without stroke on post-operative imaging. Analyses encompassed pre- and postoperative clinical, radiological, intraoperative monitoring, survival, functional and neurocognitive outcomes. Between 2013 and 2017, 63 LGG and 209 GBM patients (272 in total) underwent surgical resection and were included in our cohort. Post-op rim restriction was demonstrated in 68 patients, 32% (n = 20) of LGG and 23% (n = 48) of GBM patients. Risk factors for restriction included temporal tumors in GBM (p = 0.025) and insular tumors in LGG (p = 0.09), including longer surgery duration in LGG (p = 0.008). After a 1-year follow-up, LGG patients operated on their dominant with post-op restriction had a higher rate of speech deficits (46 vs 9%, p = 0.004). Rim restriction on postoperative imaging is associated with longer duration of glioma surgery and potentially linked to brain retraction. It apparently has no direct clinical consequences, but is linked to higher rates of speech deficits in LGG dominant-side surgeries.
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Affiliation(s)
- Assaf Berger
- Department of Neurosurgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,Center for Advanced Radiosurgery, NYU Langone Medical Center, New York University, 530 First Avenue, New York, NY, 10016, USA.
| | | | - Marga Serafimova
- Department of Neurosurgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Pablo Valdes
- Department of Neurosurgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aaron Meller
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Akiva Korn
- Department of Neurosurgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Naomi Kahana Levy
- Department of Neurosurgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Aviram
- Division of Anesthesiology, Tel-Aviv University, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zvi Ram
- Department of Neurosurgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rachel Grossman
- Department of Neurosurgery, Tel Aviv Medical Center, 6 Weizmann St., Tel Aviv, 6423906, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Aabedi AA, Young JS, Chang EF, Berger MS, Hervey-Jumper SL. Involvement of White Matter Language Tracts in Glioma: Clinical Implications, Operative Management, and Functional Recovery After Injury. Front Neurosci 2022; 16:932478. [PMID: 35898410 PMCID: PMC9309688 DOI: 10.3389/fnins.2022.932478] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
To achieve optimal survival and quality of life outcomes in patients with glioma, the extent of tumor resection must be maximized without causing injury to eloquent structures. Preservation of language function is of particular importance to patients and requires careful mapping to reveal the locations of cortical language hubs and their structural and functional connections. Within this language network, accurate mapping of eloquent white matter tracts is critical, given the high risk of permanent neurological impairment if they are injured during surgery. In this review, we start by describing the clinical implications of gliomas involving white matter language tracts. Next, we highlight the advantages and limitations of methods commonly used to identify these tracts during surgery including structural imaging techniques, functional imaging, non-invasive stimulation, and finally, awake craniotomy. We provide a rationale for combining these complementary techniques as part of a multimodal mapping paradigm to optimize postoperative language outcomes. Next, we review local and long-range adaptations that take place as the language network undergoes remodeling after tumor growth and surgical resection. We discuss the probable cellular mechanisms underlying this plasticity with emphasis on the white matter, which until recently was thought to have a limited role in adults. Finally, we provide an overview of emerging developments in targeting the glioma-neuronal network interface to achieve better disease control and promote recovery after injury.
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Neurosurgical Clinical Trials for Glioblastoma: Current and Future Directions. Brain Sci 2022; 12:brainsci12060787. [PMID: 35741672 PMCID: PMC9221299 DOI: 10.3390/brainsci12060787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2023] Open
Abstract
The mainstays of glioblastoma treatment, maximal safe resection, radiotherapy preserving neurological function, and temozolomide (TMZ) chemotherapy have not changed for the past 17 years despite significant advances in the understanding of the genetics and molecular biology of glioblastoma. This review highlights the neurosurgical foundation for glioblastoma therapy. Here, we review the neurosurgeon’s role in several new and clinically-approved treatments for glioblastoma. We describe delivery techniques such as blood–brain barrier disruption and convection-enhanced delivery (CED) that may be used to deliver therapeutic agents to tumor tissue in higher concentrations than oral or intravenous delivery. We mention pivotal clinical trials of immunotherapy for glioblastoma and explain their outcomes. Finally, we take a glimpse at ongoing clinical trials and promising translational studies to predict ways that new therapies may improve the prognosis of patients with glioblastoma.
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43
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Weiss Lucas C, Faymonville AM, Loução R, Schroeter C, Nettekoven C, Oros-Peusquens AM, Langen KJ, Shah NJ, Stoffels G, Neuschmelting V, Blau T, Neuschmelting H, Hellmich M, Kocher M, Grefkes C, Goldbrunner R. Surgery of Motor Eloquent Glioblastoma Guided by TMS-Informed Tractography: Driving Resection Completeness Towards Prolonged Survival. Front Oncol 2022; 12:874631. [PMID: 35692752 PMCID: PMC9186060 DOI: 10.3389/fonc.2022.874631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Surgical treatment of patients with glioblastoma affecting motor eloquent brain regions remains critically discussed given the risk–benefit dilemma of prolonging survival at the cost of motor-functional damage. Tractography informed by navigated transcranial magnetic stimulation (nTMS-informed tractography, TIT) provides a rather robust estimate of the individual location of the corticospinal tract (CST), a highly vulnerable structure with poor functional reorganisation potential. We hypothesised that by a more comprehensive, individualised surgical decision-making using TIT, tumours in close relationship to the CST can be resected with at least equal probability of gross total resection (GTR) than less eloquently located tumours without causing significantly more gross motor function harm. Moreover, we explored whether the completeness of TIT-aided resection translates to longer survival. Methods A total of 61 patients (median age 63 years, m = 34) with primary glioblastoma neighbouring or involving the CST were operated on between 2010 and 2015. TIT was performed to inform surgical planning in 35 of the patients (group T; vs. 26 control patients). To achieve largely unconfounded group comparisons for each co-primary outcome (i.e., gross-motor functional worsening, GTR, survival), (i) uni- and multivariate regression analyses were performed to identify features of optimal outcome prediction; (ii), optimal propensity score matching (PSM) was applied to balance those features pairwise across groups, followed by (iii) pairwise group comparison. Results Patients in group T featured a significantly higher lesion-CST overlap compared to controls (8.7 ± 10.7% vs. 3.8 ± 5.7%; p = 0.022). The frequency of gross motor worsening was higher in group T, albeit non-significant (n = 5/35 vs. n = 0/26; p = 0.108). PSM-based paired-sample comparison, controlling for the confounders of preoperative tumour volume and vicinity to the delicate vasculature of the insula, showed higher GTR rates in group T (77% vs. 69%; p = 0.025), particularly in patients with a priori intended GTR (87% vs. 78%; p = 0.003). This translates into a prolonged PFS in the same PSM subgroup (8.9 vs. 5.8 months; p = 0.03), with GTR representing the strongest predictor of PFS (p = 0.001) and OS (p = 0.0003) overall. Conclusion The benefit of TIT-aided GTR appears to overcome the drawbacks of potentially elevated motor functional risk in motor eloquent tumour localisation, leading to prolonged survival of patients with primary glioblastoma close to the CST.
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Affiliation(s)
- Carolin Weiss Lucas
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andrea Maria Faymonville
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Ricardo Loução
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany
| | - Catharina Schroeter
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Charlotte Nettekoven
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Karl Josef Langen
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany.,JARA - BRAIN - Translational Medicine, Aachen, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany
| | - Volker Neuschmelting
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Blau
- Department of Neurology, RWTH Aachen University, Aachen, Germany.,Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hannah Neuschmelting
- Institute of Pathology and Neuropathology, University Hospital Essen, Essen, Germany
| | - Martin Hellmich
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Kocher
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Stereotaxy and Functional Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany
| | - Christian Grefkes
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Julich, Juelich, Germany.,Institute for Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Roland Goldbrunner
- Department of General Neurosurgery, Center of Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Nichols NM, Hadjipanayis CG. Editorial. Supramaximal resection of eloquent glioblastoma: a continued paradigm shift in neurosurgical oncology. J Neurosurg 2022; 138:58-60. [PMID: 35623364 DOI: 10.3171/2022.3.jns22564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Noah M Nichols
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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45
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Bernstock JD, Gary SE, Klinger N, Valdes PA, Ibn Essayed W, Olsen HE, Chagoya G, Elsayed G, Yamashita D, Schuss P, Gessler FA, Peruzzi PP, Bag A, Friedman GK. Standard clinical approaches and emerging modalities for glioblastoma imaging. Neurooncol Adv 2022; 4:vdac080. [PMID: 35821676 PMCID: PMC9268747 DOI: 10.1093/noajnl/vdac080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Glioblastoma (GBM) is the most common primary adult intracranial malignancy and carries a dismal prognosis despite an aggressive multimodal treatment regimen that consists of surgical resection, radiation, and adjuvant chemotherapy. Radiographic evaluation, largely informed by magnetic resonance imaging (MRI), is a critical component of initial diagnosis, surgical planning, and post-treatment monitoring. However, conventional MRI does not provide information regarding tumor microvasculature, necrosis, or neoangiogenesis. In addition, traditional MRI imaging can be further confounded by treatment-related effects such as pseudoprogression, radiation necrosis, and/or pseudoresponse(s) that preclude clinicians from making fully informed decisions when structuring a therapeutic approach. A myriad of novel imaging modalities have been developed to address these deficits. Herein, we provide a clinically oriented review of standard techniques for imaging GBM and highlight emerging technologies utilized in disease characterization and therapeutic development.
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Affiliation(s)
- Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Sam E Gary
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham , AL, USA
| | - Neil Klinger
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Pablo A Valdes
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Hannah E Olsen
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , AL, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , AL, USA
| | - Daisuke Yamashita
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , AL, USA
| | - Patrick Schuss
- Department of Neurosurgery, Unfallkrankenhaus Berlin , Berlin, Germany
| | | | - Pier Paolo Peruzzi
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Asim Bag
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital , Memphis, TN USA
| | - Gregory K Friedman
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , AL, USA
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham , Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham , AL, USA
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46
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Supramarginal Resection for Glioblastoma: It Is Time to Set Boundaries! A Critical Review on a Hot Topic. Brain Sci 2022; 12:brainsci12050652. [PMID: 35625037 PMCID: PMC9139451 DOI: 10.3390/brainsci12050652] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023] Open
Abstract
Glioblastoma are the most common primary malignant brain tumors with a highly infiltrative behavior. The extent of resection of the enhancing component has been shown to be correlated to survival. Recently, it has been proposed to move the resection beyond the contrast-enhanced portion into the MR hyper intense tissue which typically surrounds the tumor, the so-called supra marginal resection (SMR). Though it should be associated with better overall survival (OS), a potential harmful resection must be avoided in order not to create new neurological deficits. Through this work, we aimed to perform a critical review of SMR in patients with Glioblastoma. A Medline database search and a pooled meta-analysis of HRs were conducted; 19 articles were included. Meta-analysis revealed a pooled OS HR of 0.64 (p = 0.052). SMR is generally considered as the resection of any T1w gadolinium-enhanced tumor exceeding FLAIR volume, but no consensus exists about the amount of volume that must be resected to have an OS gain. Equally, the role and the weight of several pre-operative features (tumor volume, location, eloquence, etc.), the intraoperative methods to extend resection, and the post-operative deficits, need to be considered more deeply in future studies.
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Ruiz-Garcia H, Middlebrooks EH, Trifiletti DM, Chaichana KL, Quinones-Hinojosa A, Sheehan JP. The Extent of Resection in Gliomas-Evidence-Based Recommendations on Methodological Aspects of Research Design. World Neurosurg 2022; 161:382-395.e3. [PMID: 35505558 DOI: 10.1016/j.wneu.2021.08.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Modern neurosurgery has established maximal safe resection as a cornerstone in the management of diffuse gliomas. Evaluation of the extent of resection (EOR), and its association with certain outcomes or interventions, heavily depends on an adequate methodology to draw strong conclusions. We aim to identify weaknesses and limitations that may threaten the internal validity and generalizability of studies involving the EOR in patients with glioma and to suggest methodological recommendations that may help mitigate these threats. METHODS A systematic search was performed by querying PubMed, Web of Science, and Scopus since inception to April 30, 2021 using PICOS/PRISMA guidelines. Articles were then screened to identify high-impact studies evaluating the EOR in patients diagnosed with diffuse gliomas in accordance with predefined criteria. We identify common weakness and limitations during the evaluation of the EOR in the selected studies and then delineate potential methodological recommendations for future endeavors dealing with the EOR. RESULTS We identified 31 high-impact studies and found several research design issues including inconsistencies regarding EOR terminology, measurement, data collection, analysis, and reporting. Although some of these issues were related to now outdated reporting standards, many were still present in recent publications and deserve attention in contemporary and future research. CONCLUSIONS There is a current need to focus more attention to the methodological aspects of glioma research. Methodological inconsistencies may introduce weaknesses into the internal validity of the studies and hamper comparative analysis of cohorts from different institutions. We hope our recommendations will eventually help develop stronger methodological designs in future research endeavors.
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Affiliation(s)
- Henry Ruiz-Garcia
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Erik H Middlebrooks
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Daniel M Trifiletti
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
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Young JS, Gogos AJ, Aabedi AA, Morshed RA, Pereira MP, Lashof-Regas S, Mansoori Z, Luks T, Hervey-Jumper SL, Villanueva-Meyer JE, Berger MS. Resection of supplementary motor area gliomas: revisiting supplementary motor syndrome and the role of the frontal aslant tract. J Neurosurg 2022; 136:1278-1284. [PMID: 34598138 DOI: 10.3171/2021.4.jns21187] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The supplementary motor area (SMA) is an eloquent region that is frequently a site for glioma, or the region is included in the resection trajectory to deeper lesions. Although the clinical relevance of SMA syndrome has been well described, it is still difficult to predict who will become symptomatic. The object of this study was to define which patients with SMA gliomas would go on to develop a postoperative SMA syndrome. METHODS The University of California, San Francisco, tumor registry was searched for patients who, between 2010 and 2019, had undergone resection for newly diagnosed supratentorial diffuse glioma (WHO grades II-IV) performed by the senior author and who had at least 3 months of follow-up. Pre- and postoperative MRI studies were reviewed to confirm the tumor was located in the SMA region, and the extent of SMA resection was determined by volumetric assessment. Patient, tumor, and outcome data were collected retrospectively from documents available in the electronic medical record. Tumors were registered to a standard brain atlas to create a frequency heatmap of tumor volumes and resection cavities. RESULTS During the study period, 56 patients (64.3% male, 35.7% female) underwent resection of a newly diagnosed glioma in the SMA region. Postoperatively, 60.7% developed an SMA syndrome. Although the volume of tumor within the SMA region did not correlate with the development of SMA syndrome, patients with the syndrome had larger resection cavities in the SMA region (25.4% vs 14.2% SMA resection, p = 0.039). The size of the resection cavity in the SMA region did not correlate with the severity of the SMA syndrome. Patients who developed the syndrome had cavities that were located more posteriorly in the SMA region and in the cingulate gyrus. When the frontal aslant tract (FAT) was preserved, 50% of patients developed the SMA syndrome postoperatively, whereas 100% of the patients with disruption of the FAT during surgery developed the SMA syndrome (p = 0.06). Patients with SMA syndrome had longer lengths of stay (5.6 vs 4.1 days, p = 0.027) and were more likely to be discharged to a rehabilitation facility (41.9% vs 0%, p < 0.001). There was no difference in overall survival for newly diagnosed glioblastoma patients with SMA syndrome compared to those without SMA syndrome (1.6 vs 3.0 years, p = 0.33). CONCLUSIONS For patients with SMA glioma, more extensive resections and resections involving the posterior SMA region and posterior cingulate gyrus increased the likelihood of a postoperative SMA syndrome. Although SMA syndrome occurred in all cases in which the FAT was resected, FAT preservation does not reliably avoid SMA syndrome postoperatively.
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Affiliation(s)
- Jacob S Young
- 1Department of Neurological Surgery, University of California, San Francisco
| | - Andrew J Gogos
- 1Department of Neurological Surgery, University of California, San Francisco
| | | | - Ramin A Morshed
- 1Department of Neurological Surgery, University of California, San Francisco
| | | | | | - Ziba Mansoori
- 3Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Tracy Luks
- 3Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | | | - Javier E Villanueva-Meyer
- 3Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Mitchel S Berger
- 1Department of Neurological Surgery, University of California, San Francisco
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49
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Fuster-Garcia E, Thokle Hovden I, Fløgstad Svensson S, Larsson C, Vardal J, Bjørnerud A, Emblem KE. Quantification of Tissue Compression Identifies High-Grade Glioma Patients with Reduced Survival. Cancers (Basel) 2022; 14:cancers14071725. [PMID: 35406497 PMCID: PMC8997138 DOI: 10.3390/cancers14071725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 02/01/2023] Open
Abstract
The compression of peritumoral healthy tissue in brain tumor patients is considered a major cause of the life-threatening neurologic symptoms. Although significant deformations caused by the tumor growth can be observed radiologically, the quantification of minor tissue deformations have not been widely investigated. In this study, we propose a method to quantify subtle peritumoral deformations. A total of 127 MRI longitudinal studies from 23 patients with high-grade glioma were included. We estimate longitudinal displacement fields based on a symmetric normalization algorithm and we propose four biomarkers. We assess the interpatient and intrapatient association between proposed biomarkers and the survival based on Cox analyses, and the potential of the biomarkers to stratify patients according to their survival based on Kaplan−Meier analysis. Biomarkers show a significant intrapatient association with survival (p < 0.05); however, only compression biomarkers show the ability to stratify patients between those with higher and lower overall survival (AUC = 0.83, HR = 6.30, p < 0.05 for CompCH). The compression biomarkers present three times higher Hazard Ratios than those representing only displacement. Our study provides a robust and automated method for quantifying and delineating compression in the peritumoral area. Based on the proposed methodology, we found an association between lower compression in the peritumoral area and good prognosis in high-grade glial tumors.
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Affiliation(s)
- Elies Fuster-Garcia
- Biomedical Data Science Laboratory, Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, 46022 Valencia, Spain
- Correspondence:
| | - Ivar Thokle Hovden
- Department of Diagnostic Physics, Oslo University Hospital, 0372 Oslo, Norway; (I.T.H.); (S.F.S.); (K.E.E.)
- Department of Physics, University of Oslo, 0316 Oslo, Norway;
| | - Siri Fløgstad Svensson
- Department of Diagnostic Physics, Oslo University Hospital, 0372 Oslo, Norway; (I.T.H.); (S.F.S.); (K.E.E.)
- Department of Physics, University of Oslo, 0316 Oslo, Norway;
| | - Christopher Larsson
- Department of Neurosurgery, Oslo University Hospital, 0372 Oslo, Norway;
- Unit for Computational Radiology and Artificial Intelligence, Oslo University Hospital, 0372 Oslo, Norway;
| | - Jonas Vardal
- Unit for Computational Radiology and Artificial Intelligence, Oslo University Hospital, 0372 Oslo, Norway;
- Department of Radiology, Drammen Hospital, Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Atle Bjørnerud
- Department of Physics, University of Oslo, 0316 Oslo, Norway;
- Unit for Computational Radiology and Artificial Intelligence, Oslo University Hospital, 0372 Oslo, Norway;
- Department of Psychology, Faculty for Social Sciences, University of Oslo, 0851 Oslo, Norway
| | - Kyrre E. Emblem
- Department of Diagnostic Physics, Oslo University Hospital, 0372 Oslo, Norway; (I.T.H.); (S.F.S.); (K.E.E.)
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Gerritsen JKW, Broekman MLD, De Vleeschouwer S, Schucht P, Nahed BV, Berger MS, Vincent AJPE. Safe Surgery for Glioblastoma: Recent Advances and Modern Challenges. Neurooncol Pract 2022; 9:364-379. [PMID: 36127890 PMCID: PMC9476986 DOI: 10.1093/nop/npac019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
One of the major challenges during glioblastoma surgery is balancing between maximizing extent of resection and preventing neurological deficits. Several surgical techniques and adjuncts have been developed to help identify eloquent areas both preoperatively (fMRI, nTMS, MEG, DTI) and intraoperatively (imaging (ultrasound, iMRI), electrostimulation (mapping), cerebral perfusion measurements (fUS)), and visualization (5-ALA, fluoresceine)). In this review, we give an update of the state-of-the-art management of both primary and recurrent glioblastomas. We will review the latest surgical advances, challenges, and approaches that define the onco-neurosurgical practice in a contemporary setting and give an overview of the current prospective scientific efforts.
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Affiliation(s)
| | | | | | - Philippe Schucht
- Department of Neurosurgery, University Hospital Bern, Switzerland
| | - Brian Vala Nahed
- Department of Neurosurgery, Massachusetts General Hospital/Harvard Medical School, Boston MA, USA
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