scholarly journals Pediatric Non–Brain Stem High-Grade Glioma: A Single-Center Experience

2020 ◽  
Vol 9 (03) ◽  
pp. 162-169
Author(s):  
Ehsan Alimohammadi ◽  
Seyed Reza Bagheri ◽  
Nasrin Delfani ◽  
Roya Safari-Faramani ◽  
Maryam Janatolmakan
Keyword(s):  
Brain Stem ◽  
Poor Prognosis ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
Tumor Location ◽  
High Grade ◽  
Related Factors ◽  
Single Center Experience ◽  
The Impact

Abstract Background Pediatric high-grade gliomas (PHGGs) consist of a heterogeneous class of central nervous system (CNS) neoplasms with a poor prognosis. We aimed to present our 10-year experience in the management of children with high-grade glioma focusing on patients’ survival and related factors. Methods All pediatric patients with high- grade glioma (HGG) who were admitted to our center between May 2009 and May 2018 were investigated. Overall survival (OS) was calculated from the time of diagnosis until the day of death. The impact of suggested variables on survival was evaluated using the univariate and multivariate analyses. Results There were 41 children with non–brain stem high-grade glioma (NBSHGG). The mean OS of patients was 21.24 ± 10.16 months. The extent of resection (p = 0.002, hazard ratio [HR] = 4.84), the grade of the tumor (p = 0.017, HR = 4.36), and temozolomide (TMZ) therapy (p = 0.038, HR = 3.57) were the independent predictors of OS in children with NBSHGG. Age, gender, tumor location, and size of tumor were not associated with the survival of these patients. Conclusion HGGs are uncommon pediatric tumors with an aggressive nature and a poor prognosis. Our results revealed that in NBSHGG cases, children with maximal safe tumor resection and children that received temozolomide therapy as well as children with grade III of the tumor had higher survival.

scholarly journals Brain atlas for assessing the impact of tumor location on perioperative quality of life in patients with high-grade glioma: A prospective population-based cohort study

2019 ◽  
Vol 21 ◽  
pp. 101658 ◽  
Author(s):  
Lisa Millgård Sagberg ◽  
Daniel Høyer Iversen ◽  
Even Hovig Fyllingen ◽  
Asgeir Store Jakola ◽  
Ingerid Reinertsen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
High Grade Glioma ◽  
Tumor Location ◽  
Population Based ◽  
Brain Atlas ◽  
High Grade ◽  
The Impact

scholarly journals Navigated Intraoperative 2-Dimensional Ultrasound in High-Grade Glioma Surgery: Impact on Extent of Resection and Patient Outcome

2019 ◽  
Author(s):  
Alessandro Moiraghi ◽  
Francesco Prada ◽  
Alberto Delaidelli ◽  
Ramona Guatta ◽  
Adrien May ◽  
...  
Keyword(s):  
Real Time ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Intraoperative Ultrasound ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
High Grade ◽  
Glioma Surgery ◽  
Supratentorial Gliomas ◽  
The Impact

Abstract BACKGROUND Maximizing extent of resection (EOR) and reducing residual tumor volume (RTV) while preserving neurological functions is the main goal in the surgical treatment of gliomas. Navigated intraoperative ultrasound (N-ioUS) combining the advantages of ultrasound and conventional neuronavigation (NN) allows for overcoming the limitations of the latter. OBJECTIVE To evaluate the impact of real-time NN combining ioUS and preoperative magnetic resonance imaging (MRI) on maximizing EOR in glioma surgery compared to standard NN. METHODS We retrospectively reviewed a series of 60 cases operated on for supratentorial gliomas: 31 operated under the guidance of N-ioUS and 29 resected with standard NN. Age, location of the tumor, pre- and postoperative Karnofsky Performance Status (KPS), EOR, RTV, and, if any, postoperative complications were evaluated. RESULTS The rate of gross total resection (GTR) in NN group was 44.8% vs 61.2% in N-ioUS group. The rate of RTV > 1 cm3 for glioblastomas was significantly lower for the N-ioUS group (P < .01). In 13/31 (42%), RTV was detected at the end of surgery with N-ioUS. In 8 of 13 cases, (25.8% of the cohort) surgeons continued with the operation until complete resection. Specificity was greater in N-ioUS (42% vs 31%) and negative predictive value (73% vs 54%). At discharge, the difference between pre- and postoperative KPS was significantly higher for the N-ioUS (P < .01). CONCLUSION The use of an N-ioUS-based real-time has been beneficial for resection in noneloquent high-grade glioma in terms of both EOR and neurological outcome, compared to standard NN. N-ioUS has proven usefulness in detecting RTV > 1 cm3.

scholarly journals SURG-12. PREDICTORS OF SURVIVAL AND UTILITY OF INTRAOPERATIVE MRI FOR RESECTION OF GRADE II ASTROCYTOMAS AND OLIGODENDROGLIOMAS: A MULTICENTER ANALYSIS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii205-ii206
Author(s):  
Alexander Yahanda ◽  
Bhuvic Patel ◽  
Amar Shah ◽  
Daniel Cahill ◽  
Garnette Sutherland ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Intraoperative Mri ◽  
Patient Treatment ◽  
Subtotal Resection ◽  
Related Factors ◽  
Kaplan Meier ◽  
Grade Ii ◽  
The Impact

Abstract BACKGROUND Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative MRI (iMRI) in the resection of grade II gliomas. We assessed the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly-diagnosed grade II astrocytomas and oligodendrogliomas. METHODS Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS/PFS. RESULTS 232 resections (112 astrocytomas, 120 oligodendrogliomas; 135 males; mean age 36.2 ± 0.9 years) were analyzed. Oligodendrogliomas had longer OS (p&lt; 0.001) and PFS (p=0.009) than astrocytomas. Multivariate regression showed that extent of resection (EOR), including gross-total (GTR) versus near-total (NTR) resection (p=0.02, HR: 0.64, 95% CI: 0.25-.79) and GTR versus subtotal resection (STR) (p=0.006, HR: 0.23, 95% CI: 0.08-0.66), was associated with longer OS. GTR versus NTR (p=0.04, HR: 0.49, 95% CI: 0.29-.85), GTR versus STR (p=0.02, HR: .54, 95% CI: .32-.91) and iMRI use (p=0.02, HR: 0.54, 95% CI: 0.32-0.92) were associated with longer PFS. Frontal (p=0.048, HR: 2.11, 95% CI: 1.01-4.43) and occipital/parietal (p=0.003, HR: 3.59, 95% CI: 1.52-8.49) locations were associated with shorter PFS (versus temporal). Kaplan-Meier analyses showed longer OS with increasing EOR (p=0.03) and 1p/19q gene deletions (p=0.02). PFS improved with increasing EOR (p=0.01), GTR versus NTR (p=0.02), and resections above STR (p=0.04). Factors influencing adjuvant treatment (35.3% of patients) included age (p=0.002, OR: 1.04) and EOR (p=0.037, OR: 0.41 for NTR versus STR; p=0.003, OR: 0.39 for GTR versus STR), but not glioma subtype or location, as determined by logistic regression. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these cases. CONCLUSIONS EOR significantly improves OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.

scholarly journals P.159 Association Between Extent of Resection and Survival in Pediatric Patients with High-Grade Glioma: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 48 (s3) ◽  
pp. S65-S65
Author(s):  
R Hatoum ◽  
J Chen ◽  
P Lavergne ◽  
N Shlobin ◽  
A Wang ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Meta Analysis ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Included Study ◽  
Prolonged Survival ◽  
Subtotal Resection ◽  
High Grade ◽  
The Relationship

Background: While pediatric high-grade glioma (HGG) has a poor prognosis, the relationship between extent of resection (EOR), tumor location, and survival remains unclear. Our aim is to determine whether gross-total resection (GTR) is associated with prolonged survival relative to subtotal resection (STR) and biopsy. Methods: PubMed, Ovid EBM Reviews, Embase, and MEDLINE were systematically reviewed. Eligible articles were included for study-level and individual-patient data (IPD) meta-analysis. Difference by study-level and IPD characteristics were estimated using subgroup meta-analysis and meta-regression. PRISMA guidelines were followed. Results: In total, 33 studies were included. Study-level meta-analysis found GTR conferred decreased mortality relative to STR at 1 year (RR=0.73, 95%CI=0.59-0.89) and 2 years (RR=0.74, 95%CI=0.64-0.84). STR did not demonstrate survival advantages compared to biopsy at 1 year (RR=0.81, 95%CI=0.64-1.03), but showed decreased mortality at 2 years (RR=0.90, 95%CI=0.82-0.99). IPD meta-analysis comprised 186 patients, and indicated that STR (HR=2.61, 95%CI=1.56-4.38) and biopsy (HR=2.83, 95%CI=1.54-5.19) had shortened survival relative to GTR, with no differences between STR and biopsy (HR=0.93, 95%CI=0.55-1.56). In subgroup analysis, GTR was associated with prolonged survival for hemispheric tumors (HR=0.16, 95%CI=0.07-0.36) Conclusions: Among pediatric patients with HGGs, GTR was independently associated with better overall survival compared to STR and biopsy, especially in patients with hemispheric tumors.

scholarly journals SURG-18. 5-AMINOLEVULINIC ACID FLUORESCENCE (5-ALA) GUIDED RESECTION OF GLIOBLASTOMA, LESSON LEARNED FROM 19 CASES

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi243-vi243
Author(s):  
Jinmo Cho
Keyword(s):  
Aminolevulinic Acid ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
High Grade ◽  
Total Resection ◽  
Glioma Surgery ◽  
Term Survival ◽  
Tumor Bed ◽  
Key Factor

Abstract BACKGROUND 5-ALA is known as useful tool for high grade glioma resection and the accumulation extent of 5-ALA is known as far beyond gadolinium enhancement. Extent of resection is key factor for favorable outcome and long-term survival for high grade glioma patients and 5-ALA might increase extent of resection. We present our experience of 5-ALA guided glioma surgeries METHODS Total 19 patients were performed 5-ALA guided surgery. They ingested 20mg/kg, four hours before craniotomy. We tried to perform supra-total resection rather than gross total resection according to the tumor consistency and if the tumor located relatively non-eloquent area, we tried to perform lobectomy rather than lesionectomy. After tumor resection, we inspect the tumor bed under 5-ALA fluorescence, and we confirmed the complete loss of fluorescence on the tumor resected bed. We check the MRI within 48 hour after operation and assess the extent of resection RESULTS Among the 19 patients, 15 patients were confirmed glioblastoma and 3 anaplastic astrocytoma and 1 anaplastic oligoastrocytoma. We confirmed all enhancing lesion was completely removed, however, 2 patients show residual non-enhancing lesion in post-operative MRI. Two patients suffered temporary hemiparesis and 2 patients show permanent visual field defect. CONCLUSION 5-ALA is useful tool for glioma surgery. Resection extent could be increased, however, non-enhancing lesion in the high grade gliomas, might be missed under 5-ALA guidance.

scholarly journals The impact of high functional connectivity network hub resection on language task performance in adult low- and high-grade glioma

2020 ◽  
pp. 1-11 ◽  
Author(s):  
Anthony T. Lee ◽  
Claire Faltermeier ◽  
Ramin A. Morshed ◽  
Jacob S. Young ◽  
Sofia Kakaizada ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Tumor Progression ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
High Grade ◽  
Motor Mapping ◽  
Diffuse White Matter ◽  
Language Deficit ◽  
Syllable Repetition ◽  
The Impact

OBJECTIVEGliomas are intrinsic brain tumors with the hallmark of diffuse white matter infiltration, resulting in short- and long-range network dysfunction. Preoperative magnetoencephalography (MEG) can assist in maximizing the extent of resection while minimizing morbidity. While MEG has been validated in motor mapping, its role in speech mapping remains less well studied. The authors assessed how the resection of intraoperative electrical stimulation (IES)–negative, high functional connectivity (HFC) network sites, as identified by MEG, impacts language performance.METHODSResting-state, whole-brain MEG recordings were obtained from 26 patients who underwent perioperative language evaluation and glioma resection that was guided by awake language and IES mapping. The functional connectivity of an individual voxel was determined by the imaginary coherence between the index voxel and the rest of the brain, referenced to its contralesional pair. The percentage of resected HFC voxels was correlated with postoperative language outcomes in tasks of increasing complexity: text reading, 4-syllable repetition, picture naming, syntax (SYN), and auditory stimulus naming (AN).RESULTSOverall, 70% of patients (14/20) in whom any HFC tissue was resected developed an early postoperative language deficit (mean 2.3 days, range 1–8 days), compared to 33% of patients (2/6) in whom no HFC tissue was resected (p = 0.16). When bifurcated by the amount of HFC tissue that was resected, 100% of patients (3/3) with an HFC resection > 25% displayed deficits in AN, compared to 30% of patients (6/20) with an HFC resection < 25% (p = 0.04). Furthermore, there was a linear correlation between the severity of AN and SYN decline with percentage of HFC sites resected (p = 0.02 and p = 0.04, respectively). By 2.2 months postoperatively (range 1–6 months), the correlation between HFC resection and both AN and SYN decline had resolved (p = 0.94 and p = 1.00, respectively) in all patients (9/9) except two who experienced early postoperative tumor progression or stroke involving inferior frontooccipital fasciculus.CONCLUSIONSImaginary coherence measures of functional connectivity using MEG are able to identify HFC network sites within and around low- and high-grade gliomas. Removal of IES-negative HFC sites results in early transient postoperative decline in AN and SYN, which resolved by 3 months in all patients without stroke or early tumor progression. Measures of functional connectivity may therefore be a useful means of counseling patients about postoperative risk and assist with preoperative surgical planning.

scholarly journals SURG-39. 5-AMINOLEVULINIC ACID FLUORESCENCE (5-ALA) GUIDED RESECTION OF GLIOBLASTOMA, LESSON LEARNED FROM 26 CASES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii211-ii212
Author(s):  
Jinmo Cho
Keyword(s):  
Aminolevulinic Acid ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
High Grade ◽  
Total Resection ◽  
Glioma Surgery ◽  
Term Survival ◽  
Tumor Bed ◽  
Key Factor

Abstract INTRODUCTION 5-ALA is known as useful tool for high grade glioma resection and the accumulation extent of 5-ALA is known as far beyond gadolinium enhancement. Extent of resection is key factor for favorable outcome and long-term survival for high grade glioma patients and 5-ALA might increase extent of resection. We present our experience of 5-ALA guided glioma surgeries. MATERIALS AND METHODS Total 26 patients were performed 5-ALA guided surgery. They ingested 20mg/kg, four hours before craniotomy. We tried to perform supra-total resection rather than gross total resection according to the tumor consistency and if the tumor located relatively non-eloquent area, we tried to perform lobectomy rather than lesionectomy. After tumor resection, we inspect the tumor bed under 5-ALA fluorescence, and we confirmed the complete loss of fluorescence on the tumor resected bed. We check the MRI within 48 hour after operation and assess the extent of resection. RESULTS Among the 26 patients, 22 patients were confirmed glioblastoma and 3 anaplastic astrocytoma and 1 anaplastic oligoastrocytoma. We confirmed all enhancing lesion was completely removed, however, 4 patients show residual non-enhancing lesion in post-operative MRI. Two patients suffered temporary hemiparesis and 2 patients show permanent visual field defect. CONCLUSION 5-ALA is useful tool for glioma surgery. Resection extent could be increased, however, non-enhancing lesion in the high grade gliomas, might be missed under 5-ALA guidance.

scholarly journals Determining optimal clinical target volume margins in high-grade glioma based on microscopic tumor extension and magnetic resonance imaging

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shulun Nie ◽  
Yufang Zhu ◽  
Jia Yang ◽  
Tao Xin ◽  
Song Xue ◽  
...  
Keyword(s):  
Dna Methyltransferase ◽  
Goodness Of Fit ◽  
Clinical Target Volume ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
High Grade Glioma ◽  
Target Volume ◽  
Tumor Location ◽  
High Grade ◽  
Clinical Trial Registry

Abstract Introduction In this study, we performed a consecutive macropathologic analysis to assess microscopic extension (ME) in high-grade glioma (HGG) to determine appropriate clinical target volume (CTV) margins for radiotherapy. Materials and methods The study included HGG patients with tumors located in non-functional areas, and supratotal resection was performed. The ME distance from the edge of the tumor to the microscopic tumor cells surrounding brain tissue was measured. Associations between the extent of ME and clinicopathological characteristics were evaluated by multivariate linear regression (MVLR) analysis. An ME predictive model was developed based on the MVLR model. Results Between June 2017 and July 2019, 652 pathologic slides obtained from 30 HGG patients were analyzed. The mean ME distance was 1.70 cm (range, 0.63 to 2.87 cm). The MVLR analysis identified that pathologic grade, subventricular zone (SVZ) contact and O6-methylguanine-DNA methyltransferase (MGMT) methylation, isocitrate dehydrogenase (IDH) mutation and 1p/19q co-deletion status were independent variables predicting ME (all P < 0.05). A multivariable prediction model was developed as follows: YME = 0.672 + 0.513XGrade + 0.380XSVZ + 0.439XMGMT + 0.320XIDH + 0.333X1p/19q. The R-square value of goodness of fit was 0.780. The receiver operating characteristic curve proved that the area under the curve was 0.964 (P < 0.001). Conclusion ME was heterogeneously distributed across different grades of gliomas according to the tumor location and molecular marker status, which indicated that CTV delineation should be individualized. The model could predict the ME of HGG, which may help clinicians determine the CTV for individual patients. Trial registration The trial was registered with Chinese Clinical Trial Registry (ChiCTR2100046106). Registered 4 May 2021-Retrospectively registered.

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