Central Neurocytoma Treatment Modalities: A Systematic Review Assessing the Outcomes of Combined Maximal Safe Resection and Radiotherapy with Gross Total Resection

Abstract INTRODUCTION Due to the infiltrative nature of glioblastoma(GBM) outside of the contrast enhancing region in the peritumoral zone, there is increasing movement to perform supratotal resections (SpTR) by extending the edge of resection beyond the contrast enhancing portion of the tumor. However, there is currently no consensus on the potential survival benefit of SpTR in GBM as compared to gross total resection (GTR). METHODS Therefore, we performed a systematic review using PRISMA guidelines and performed a comprehensive literature search on Pubmed, EMBASE, The Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov, from inception to August 16, 2018, to identify articles comparing overall survival (OS) after SpTR versus GTR. Furthermore, we assessed study quality using the Oxford Centre for Evidence-Based Medicine guidelines. RESULTS We identified 8902 unique citations, of which 11 articles and 2 abstracts met study inclusion criteria. 925 patients underwent SpTR out of a total of 2137 patients. 9 of the 13 studies demonstrated improved survival with SpTR compared to GTR (median improvement in OS of 10.5 months), with no significant difference in post-operative complication rate. Conversely, one abstract found worsened outcomes with SpTR compared to GTR (median decrease in OS of 4 months). However, overall study quality was poor, with 12 of the 13 studies of level IV evidence and one study of level IIIb evidence. We were unable to perform a meta-analysis due to significant clinical and methodological heterogeneity amongst the studies (e.g. differences in adjuvant therapy and lack of standardization of definition of supratotal resection). CONCLUSIONS Our systematic review indicates that SpTR may be associated with improved OS compared to GTR for GBM. However, this is limited by poor study quality and significant clinical and methodological heterogeneity amongst the studies. There is need for prospective clinical trials to further establish standardized guidelines for SpTR in GBM.

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Use of intraoperative sodium tetradecyl sulfate for the treatment of a spinal epidural hemangioma

Journal of Neurosurgery Spine ◽

10.3171/spi-07/08/264 ◽

2007 ◽

Vol 7 (2) ◽

pp. 264-269 ◽

Cited By ~ 4

Author(s):

Mirza N. Baig ◽

Syed Saquib ◽

Greg Christoforidis ◽

Louis P. Caragine

Keyword(s):

Mr Imaging ◽

Gross Total Resection ◽

Treatment Modalities ◽

Sodium Tetradecyl Sulfate ◽

Imaging Findings ◽

Total Resection ◽

Intraoperative Angiography ◽

Posterior Aspect ◽

Imaging Characteristics ◽

Spinal Epidural

✓Spinal hemangiomas can be categorized into three different groups based on location. Vertebral body (VB) heman-giomas are frequent incidental findings on magnetic resonance (MR) imaging. There is a subdivision of these with spinal epidural extension that have been reported in the literature. Spinal hemangiomas can also be epidural without VB involvement; these are extremely rare with few reported cases in the thoracic epidural spinal column. The diagnosis and imaging characteristics as well as the surgical tools used in gross-total resection of spinal epidural hemangioma are not well understood. The authors present a detailed characterization of a spinal epidural hemangioma in a 30-year-old woman who presented with complaints of gradual onset of low-back pain that worsened over 1 year. The MR imaging findings indicated a large L2–S1 epidural spinal mass causing thecal sac compression. The patient underwent an L2–S1 laminectomy, and a vascular extradural mass was noted on the posterior aspect of the dura mater. Preoperative spinal angiography as well as intraoperative angiography was performed. Total resection of the tumor was achieved using intraoperative embolization with sodium tetradecyl sulfate and microscopic dissection. The postoperative MR imaging findings and clinical outcome were excellent. The findings and use of sodium tetradecyl sulfate in gross-total resection are discussed. The authors also review treatment modalities and demonstrate the utility and effectiveness of intraoperative sodium tetradecyl sulfate in gross-total resection of large difficult spinal epidural hemangiomas.

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A systematic review and meta-analysis of supratotal versus gross total resection for glioblastoma

Journal of Neuro-Oncology ◽

10.1007/s11060-020-03556-y ◽

2020 ◽

Vol 148 (3) ◽

pp. 419-431 ◽

Cited By ~ 5

Author(s):

Christina Jackson ◽

John Choi ◽

Adham M. Khalafallah ◽

Carrie Price ◽

Chetan Bettegowda ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Gross Total Resection ◽

Total Resection

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Stereotactic Radiosurgery for Recurrent Central Neurocytoma: Case Report

Neurosurgery ◽

10.1097/00006123-200102000-00043 ◽

2001 ◽

Vol 48 (2) ◽

pp. 441-443 ◽

Cited By ~ 3

Author(s):

Bruce E. Pollock ◽

Scott L. Stafford

Keyword(s):

Stereotactic Radiosurgery ◽

Tumor Recurrence ◽

Clinical Presentation ◽

Central Neurocytoma ◽

Gross Total Resection ◽

Benign Tumors ◽

Total Resection ◽

Aggressive Tumors ◽

Neurologically Intact ◽

Viable Treatment

Abstract OBJECTIVE AND IMPORTANCE Neurocytomas are typically benign tumors that have high local control rates after gross total resection. Nevertheless, tumor recurrence is possible, and some patients have aggressive tumors. CLINICAL PRESENTATION A 26-year-old woman had a recurrent, asymptomatic neurocytoma 3 years after gross total resection. INTERVENTION The patient underwent stereotactic radiosurgery for the tumor recurrence. Thirty-four months later, the patient remained neurologically intact, and the tumor had decreased significantly in size. CONCLUSION Radiosurgery may be a viable treatment option for patients with recurrent neurocytomas or for patients whose tumor resections were subtotal.

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SURG-37. SYSTEMATIC REVIEW OF GAMMA-KNIFE RADIOSURGERY AND MICROSURGICAL RESECTION FOR BRAINSTEM CAVERNOUS MALFORMATIONS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.883 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii211-ii211

Author(s):

Aditya Kondajji ◽

Thien Nguyen ◽

John Sheppard ◽

Daniel Kulinich ◽

Ansley Unterberger ◽

...

Keyword(s):

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Therapeutic Benefit ◽

Gross Total Resection ◽

Treatment Modalities ◽

Bleeding Events ◽

Total Resection ◽

Cavernous Malformations ◽

Microsurgical Resection ◽

Meta Analyses

Abstract BACKGROUND Although microsurgical resection (MR) remains the gold-standard for the treatment of symptomatic cavernous malformations, some authors have proposed the use of radiosurgical Gamma-Knife Surgery (GKS) for lesions that are deep or eloquent, such as those located in the brainstem. OBJECTIVE Here were analyze the literature regarding patient outcomes following MR or GKS for brain stem cavernous malformations. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic literature review. A database search of PubMed, Scopus, Embase, and Web of Science was conducted in September 2019. This review included studies evaluating the outcomes of MR or GKS for cavernous malformations located in the brainstem. RESULTS Gross total resection was achieved in the majority of patients and effectively eliminated the risk of recurrent hemorrhage from the operative lesion in studies following the outcomes of MR. GKS reduces the annual hemorrhage rate for patients, although it does not eliminate the cavernous malformation. Both treatment modalities were effective in reducing prior symptomatology. Unlike resection, GKS only reduces the risk of future hemorrhage and does prevent it. CONCLUSIONS Both MR and GKS can improve or stabilize symptoms in patients. However, the therapeutic benefit of GKS may take months to years to take full-effect, resulting in a potential for subsequent hemorrhagic events. MR remains the best treatment option due to its ability to eliminate future bleeding events entirely and should be performed whenever gross total resection is possible.

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The importance of surgery as part of multimodal therapy in rapid progressive primary extraosseous Ewing sarcoma of the cervical intra- and epidural space

Clinics and Practice ◽

10.4081/cp.2016.897 ◽

2016 ◽

Vol 6 (4) ◽

Cited By ~ 1

Author(s):

Richard Bostelmann ◽

Mario Leimert ◽

Hans Jakob Steiger ◽

Kirstin Gierga ◽

Athanasios K. Petridis

Keyword(s):

Ewing Sarcoma ◽

Progression Free Survival ◽

Gross Total Resection ◽

Treatment Modalities ◽

Cervical Region ◽

Rapid Progression ◽

Total Resection ◽

Initial Surgery ◽

Uncommon Case

Primary extraosseous Ewing sarcomas (EESs) are an extremely rare pathological entity. Less than 32 cases have been reported in the literature. Here we report an uncommon case with very rapid progression in the cervical region with extra- and intradural involvement. We present a thorough review of the literature and discuss possible treatment modalities. The Medline database was searched using the search terms: Ewing sarcoma, extraosseus tumour, treatment, management, cervical spine. A previously healthy 29-year-old man complained of right-sided radiculopathy (C7). Magnetic resonance imaging showed an enhancing foraminal, sandglass shaped neurinoma- like lesion. Surgery revealed an intraand extra-dural lesion, which was histologically diagnosed as Ewing sarcoma. Despite gross total resection, there was a massive symptomatic tumor recurrence within 6 weeks. A second gross total resection was realized. The patient was treated according to the EURO E.W.I.N.G.-Protocol (VIDE) and recovered very well (progression-free interval during therapy). Several decompressive re-surgeries were realized with adjuvant radio-chemotherapy. At the last follow-up (17 months after initial surgery) the patient was in remission with a good quality of live. This case is to illustrate that despite extensive therapeutic efforts, the progression- free survival in case of primary EES may be very short. To maintain neurological function and good quality of live as long as possible, a multimodal strategy seems to be adequate. Like in the present case this implies several surgeries and adjuvant chemo-and radiotherapy. Whether this improves overall survival remains unclear.

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Endocrine and Visual Outcomes Following Gross Total Resection and Subtotal Resection of Adult Craniopharyngioma: Systematic Review and Meta-Analysis

World Neurosurgery ◽

10.1016/j.wneu.2019.03.239 ◽

2019 ◽

Vol 127 ◽

pp. e656-e668 ◽

Cited By ~ 6

Author(s):

Oluwaseun O. Akinduro ◽

Alessandro Izzo ◽

Victor M. Lu ◽

Luca Ricciardi ◽

Daniel Trifiletti ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Gross Total Resection ◽

Subtotal Resection ◽

Total Resection ◽

Visual Outcomes

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Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma: A Systematic Review and Meta-Analysis

World Neurosurgery ◽

10.1016/j.wneu.2018.08.163 ◽

2018 ◽

Vol 120 ◽

pp. e762-e775 ◽

Cited By ~ 10

Author(s):

Kaiyun Yang ◽

Siddharth Nath ◽

Alex Koziarz ◽

Jetan H. Badhiwala ◽

Huphy Ghayur ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Low Grade Glioma ◽

Gross Total Resection ◽

Low Grade ◽

Total Resection

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18F-FET-PET-guided gross total resection improves overall survival in patients with WHO grade III/IV glioma: moving towards a multimodal imaging-guided resection

Journal of Neuro-Oncology ◽

10.1007/s11060-021-03844-1 ◽

2021 ◽

Author(s):

Jonas Ort ◽

Hussam Aldin Hamou ◽

Julius M. Kernbach ◽

Karlijn Hakvoort ◽

Christian Blume ◽

...

Keyword(s):

Multimodal Imaging ◽

Tumor Volume ◽

Oncological Outcome ◽

Gross Total Resection ◽

Treatment Modalities ◽

Total Resection ◽

Who Grade ◽

Fet Pet ◽

Who Grade Iii ◽

Grade Iii

Abstract Purpose PET using radiolabeled amino acid [18F]-fluoro-ethyl-L-tyrosine (FET-PET) is a well-established imaging modality for glioma diagnostics. The biological tumor volume (BTV) as depicted by FET-PET often differs in volume and location from tumor volume of contrast enhancement (CE) in MRI. Our aim was to investigate whether a gross total resection of BTVs defined as < 1 cm3 of residual BTV (PET GTR) correlates with better oncological outcome. Methods We retrospectively analyzed imaging and survival data from patients with primary and recurrent WHO grade III or IV gliomas who underwent FET-PET before surgical resection. Tumor overlap between FET-PET and CE was evaluated. Completeness of FET-PET resection (PET GTR) was calculated after superimposition and semi-automated segmentation of pre-operative FET-PET and postoperative MRI imaging. Survival analysis was performed using the Kaplan–Meier method and the log-rank test. Results From 30 included patients, PET GTR was achieved in 20 patients. Patients with PET GTR showed improved median OS with 19.3 compared to 13.7 months for patients with residual FET uptake (p = 0.007; HR 0.3; 95% CI 0.12–0.76). This finding remained as independent prognostic factor after performing multivariate analysis (HR 0.19, 95% CI 0.06–0.62, p = 0.006). Other survival influencing factors such as age, IDH-mutation, MGMT promotor status, and adjuvant treatment modalities were equally distributed between both groups. Conclusion Our results suggest that PET GTR improves the OS in patients with WHO grade III or IV gliomas. A multimodal imaging approach including FET-PET for surgical planning in newly diagnosed and recurrent tumors may improve the oncological outcome in glioma patients.

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