The Multipotential of Leucine-Rich α-2 Glycoprotein 1 as a Clinicopathological Biomarker of Glioblastoma

Abstract Leucine-rich α-2 glycoprotein 1 (LRG1) is a diagnostic marker candidate for glioblastoma. Although LRG1 has been associated with angiogenesis, it has been suggested that its biomarker role differs depending on the type of tumor. In this study, a clinicopathological examination of LRG1’s role as a biomarker for glioblastoma was performed. We used tumor tissues of 155 cases with diffuse gliomas (27 astrocytomas, 14 oligodendrogliomas, 114 glioblastomas). The immunohistochemical LRG1 intensity scoring was classified into 2 groups: low expression and high expression. Mutations of IDH1, IDH2, and TERT promoter were analyzed through the Sanger method. We examined the relationship between LRG1 expression level in glioblastoma and clinical parameters, such as age, preoperative Karnofsky performance status, tumor location, extent of resection, O6-methylguanine DNA methyltransferase promoter, and prognosis. LRG1 high expression rate was 41.2% in glioblastoma, 3.7% in astrocytoma, and 21.4% in oligodendroglioma. Glioblastoma showed a significantly higher LRG1 expression than lower-grade glioma (p = 0.0003). High expression of LRG1 was an independent favorable prognostic factor (p = 0.019) in IDH-wildtype glioblastoma and correlated with gross total resection (p = 0.002) and the tumor location on nonsubventricular zone (p = 0.00007). LRG1 demonstrated multiple potential as a diagnostic, prognostic, and regional biomarker for glioblastoma.

Download Full-text

MPC-06 LRG1 HAS MULTIPLE POTENTIAL FOR CLINICOPATHOLOGICAL BIOMARKER OF GLIOBLASTOMA

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz039.103 ◽

2019 ◽

Vol 1 (Supplement_2) ◽

pp. ii23-ii23

Author(s):

Takuya Furuta ◽

Yasuo Sugita ◽

Satoru Komaki ◽

Kouichi Ohshima ◽

Motohiro Morioka ◽

...

Keyword(s):

Extent Of Resection ◽

Tumor Location ◽

High Expression ◽

Karnofsky Performance Scale ◽

Lower Grade ◽

Diffuse Glioma ◽

Tumor Tissues ◽

Lower Grade Glioma ◽

Expression Rate ◽

Tumor Types

Abstract BACKGROUND AND AIM Leucine-rich α-2 glycoprotein 1 (LRG1) is one of the candidate proteins as a diagnostic marker for glioblastoma. Although association with angiogenesis has been reported, it has been suggested that the role as a biomarker differs depending on the tumor types. The role of LRG1 as a biomarker in glioblastoma was examined clinicopathologically. METHODS Tumor tissues of 156 cases diagnosed as diffuse glioma (27 astrocytomas, 15 oligodendrogliomas, 114 glioblastomas) according to WHO 2016 classification at Kurume University from January 2001 to April 2019 were used. The immunohistochemical intensity of LRG1 was scoring as 4 stages and classified into 2 groups; score 0–1 was defined as low expression and score 2–3 was defined as high expression. Mutations of IDH1/2 and TERT promoter were analyzed by Sanger method. In glioblastoma, the relationship between LRG1 expression and clinical parameters such as age, preoperative Karnofsky Performance Scale, tumor location, extent of resection, MGMT promoter, and prognosis were examined. RESULTS LRG1 high expression rate was 41.2% (47/114) in glioblastoma, 3.7% (1/27) in astrocytoma, 20% (3/15) in oligodendroglioma, and glioblastoma showed significant higher expression level of LRG1 compared with lower-grade glioma (p = 0.0003). High expression of LRG1 was an independent favorable prognostic factor (HR 0.41, 95% CI 0.18–0.86, p=0.019) in IDH-wildtype glioblastoma, and correlated with gross total resection (p = 0.002) and the tumor location of the non-subventricular zone (SVZ) (p = 0.00007). CONCLUSION LRG1 demonstrated multiple potential as diagnostic, prognostic, and regional biomarker for glioblastoma.

Download Full-text

Survival benefits of hypofractionated radiotherapy combined with temozolomide or temozolomide plus bevacizumab in elderly patients with glioblastoma aged ≥ 75 years

Radiation Oncology ◽

10.1186/s13014-019-1389-7 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 6

Author(s):

Makoto Ohno ◽

Yasuji Miyakita ◽

Masamichi Takahashi ◽

Hiroshi Igaki ◽

Yuko Matsushita ◽

...

Keyword(s):

Elderly Patients ◽

Dna Methyltransferase ◽

Karnofsky Performance Status ◽

Performance Status ◽

Methylation Status ◽

Progression Free Survival ◽

Promoter Hypermethylation ◽

Hypofractionated Radiotherapy ◽

Methylguanine Dna Methyltransferase ◽

Grade 3

Abstract Background and purpose The purpose of this study was to evaluate the outcomes of elderly patients (aged ≥75 years) with newly diagnosed glioblastoma (GBM), who were treated with hypofractionated radiotherapy comprising 45 Gy in 15 fractions combined with temozolomide (TMZ) or TMZ and bevacizumab (TMZ/Bev). Materials and methods Between October 2007 and August 2018, 30 patients with GBM aged ≥75 years were treated with hypofractionated radiotherapy consisting of 45 Gy in 15 fractions. Twenty patients received TMZ and 10 received TMZ/Bev as upfront chemotherapy. O-6-methylguanine DNA methyltransferase (MGMT) promoter methylation status was analyzed by pyrosequencing. The cutoff value of the mean level of methylation at the 16 CpG sites was 16%. Results Median overall survival (OS) and progression-free survival (PFS) were 12.9 months and 9.9 months, respectively. The 1-year OS and PFS rates were 64.7 and 34.7%, respectively. Median OS and PFS did not differ significantly between patients with MGMT promoter hypermethylation (N = 11) and those with hypomethylation (N = 16) (17.4 vs. 11.8 months, p = 0.32; and 13.1 vs. 7.3 months, p = 0.11, respectively). The median OS and PFS were not significantly different between TMZ (N = 20) and TMZ/Bev (N = 10) chemotherapy (median OS: TMZ 12.9 months vs. TMZ/Bev 14.6 months, p = 0.93, median PFS: TMZ 8.5 months vs TMZ/Bev 10.0 months, p = 0.64, respectively). The median time until Karnofsky performance status (KPS) score decreasing below 60 points was 7.9 months. The best radiological responses included 11 patients with a partial response (36.7%). Grade 3/4 toxicities included leukopenia in 15 patients (50%), anorexia in 4 (13.3%), and hyponatremia during concomitant chemotherapy in 3 (10%). Conclusion Our hypofractionated radiotherapy regimen combined with TMZ or TMZ/Bev showed benefits in terms of OS, PFS, and KPS maintenance with acceptable toxicities in elderly patients with GBM aged ≥75 years.

Download Full-text

Lower-Grade Gliomas: An Epidemiological Voxel-Based Analysis of Location and Proximity to Eloquent Regions

Frontiers in Oncology ◽

10.3389/fonc.2021.748229 ◽

2021 ◽

Vol 11 ◽

Author(s):

Tomás Gómez Vecchio ◽

Alice Neimantaite ◽

Alba Corell ◽

Jiri Bartek ◽

Margret Jensdottir ◽

...

Keyword(s):

Karnofsky Performance Status ◽

Performance Status ◽

Treatment Decision ◽

Brain Regions ◽

Tumor Location ◽

Population Based ◽

World Health ◽

Lower Grade ◽

Functional Neuroanatomy ◽

Treatment Decision Making

BackgroundGlioma is the most common intra-axial tumor, and its location relative to critical areas of the brain is important for treatment decision-making. Studies often report tumor location based on anatomical taxonomy alone since the estimation of eloquent regions requires considerable knowledge of functional neuroanatomy and is, to some degree, a subjective measure. An unbiased and reproducible method to determine tumor location and eloquence is desirable, both for clinical use and for research purposes.ObjectiveTo report on a voxel-based method for assessing anatomical distribution and proximity to eloquent regions in diffuse lower-grade gliomas (World Health Organization grades 2 and 3).MethodsA multi-institutional population-based dataset of adult patients (≥18 years) histologically diagnosed with lower-grade glioma was analyzed. Tumor segmentations were registered to a standardized space where two anatomical atlases were used to perform a voxel-based comparison of the proximity of segmentations to brain regions of traditional clinical interest.ResultsExploring the differences between patients with oligodendrogliomas, isocitrate dehydrogenase (IDH) mutated astrocytomas, and patients with IDH wild-type astrocytomas, we found that the latter were older, more often had lower Karnofsky performance status, and that these tumors were more often found in the proximity of eloquent regions. Eloquent regions are found slightly more frequently in the proximity of IDH-mutated astrocytomas compared to oligodendrogliomas. The regions included in our voxel-based definition of eloquence showed a high degree of association with performing biopsy compared to resection.ConclusionWe present a simple, robust, unbiased, and clinically relevant method for assessing tumor location and eloquence in lower-grade gliomas.

Download Full-text

A Nomogram Predicts Individual Prognosis in Patients With Newly Diagnosed Glioblastoma by Integrating the Extent of Resection of Non-Enhancing Tumors

Frontiers in Oncology ◽

10.3389/fonc.2020.598965 ◽

2020 ◽

Vol 10 ◽

Author(s):

Zhe Zhang ◽

Zeping Jin ◽

Dayuan Liu ◽

Yang Zhang ◽

Chunzhao Li ◽

...

Keyword(s):

Dna Methyltransferase ◽

Proportional Hazards Model ◽

Predictive Accuracy ◽

Karnofsky Performance Status ◽

Performance Status ◽

Extent Of Resection ◽

Cox Proportional Hazards Model ◽

Newly Diagnosed ◽

Discriminative Ability ◽

Newly Diagnosed Glioblastoma

BackgroundThe extent of resection of non-contrast enhancing tumors (EOR-NCEs) has been shown to be associated with prognosis in patients with newly diagnosed glioblastoma (nGBM). This study aimed to develop and independently validate a nomogram integrated with EOR-NCE to assess individual prognosis.MethodsData for this nomogram were based on 301 patients hospitalized for nGBM from October 2011 to April 2019 at the Beijing Tiantan Hospital, Capital Medical University. These patients were randomly divided into derivation (n=181) and validation (n=120) cohorts at a ratio of 6:4. To evaluate predictive accuracy, discriminative ability, and clinical net benefit, concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were calculated for the extent of resection of contrast enhancing tumor (EOR-CE) and EOR-NCE nomograms. Comparison between these two models was performed as well.ResultsThe Cox proportional hazards model was used to establish nomograms for this study. Older age at diagnosis, Karnofsky performance status (KPS)<70, unmethylated O6-methylguanine-DNA methyltransferase (MGMT) status, wild-type isocitrate dehydrogenase enzyme (IDH), and lower EOR-CE and EOR-NCE were independent factors associated with shorter survival. The EOR-NCE nomogram had a higher C-index than the EOR-CE nomogram. Its calibration curve for the probability of survival exhibited good agreement between the identical and actual probabilities. The EOR-NCE nomogram showed superior net benefits and improved performance over the EOR-CE nomogram with respect to DCA and ROC for survival probability. These results were also confirmed in the validation cohort.ConclusionsAn EOR-NCE nomogram assessing individualized survival probabilities (12-, 18-, and 24-month) for patients with nGBM could be useful to provide patients and their relatives with health care consultations on optimizing therapeutic approaches and prognosis.

Download Full-text

PATH-16. EVALUATION OF SEX-BASED DIFFERENCES IN CLINICAL OUTCOMES AND TUMOR GENOMICS IN PATIENTS WITH NEWLY DIAGNOSED IDH-WILDTYPE GLIOBLASTOMA RECEIVING CHEMORADIATION

Neuro-Oncology ◽

10.1093/neuonc/noab196.468 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi118-vi118

Author(s):

Diana Shi ◽

Mary Jane Lim-Fat ◽

Amin Nassar ◽

Jared Woods ◽

Gilbert Youssef ◽

...

Keyword(s):

Clinical Outcomes ◽

Karnofsky Performance Status ◽

Performance Status ◽

Methylation Status ◽

Multivariable Analysis ◽

Extent Of Resection ◽

Hazard Ratio ◽

Newly Diagnosed ◽

Loss Of Function ◽

Female Sex

Abstract BACKGROUND We evaluated sex-based differences in clinical outcomes and tumor genomics in patients with newly-diagnosed GBM. METHODS We reviewed 665 IDH-wild type GBM patients with Karnofsky Performance Status (KPS) ≥60 treated at our institution from 2010-2019 including; 585 patients with targeted exome sequencing of 447 cancer associated genes (OncoPanel). Deleterious mutations were defined as homozygous deletions or loss of function mutations of known tumor suppressors (as reported in TCGA, ≥ 3 times in the COSMIC database, or predicted as “damaging” in SIFT and/or “probably damaging” in Polyphen 2) or known oncogenic mutations in proto-oncogenes (reported in TCGA or ≥ 3 times in COSMIC). RESULTS There were 384 (57.7%) males and 281 (42.3%) females. Median OS was 22.5 months for females and 19.3 months for males (hazard ratio [HR] 0.81, 95% CI 1.03-1.48, p = 0.02). On multivariable analysis adjusted for age, KPS ≥90, extent of resection, and MGMT methylation status, female sex (adjusted hazard ratio 0.78, 95% CI [0.64-0.95], p = 0.015) was associated with improved OS. Superior OS in females was observed in MGMT-unmethylated patients (HR 0.69, 95% CI [0.54-0.90], p = 0.005) but not MGMT-methylated patients. Thirteen genes were deleteriously altered in ≥5% of our cohort: CDK4 (12.1% male vs. 7.8% female), CDKN2A (46.5% vs. 45.7%), CDKN2B (41.8% vs. 43.3%), EGFR (34.7% vs. 40.0%, MTAP (18.2% vs. 18.8%), NF1 (11.5% vs. 9.4%), PTEN (28.2% vs. 29.8%), TP53 (28.2% vs. 30.2%), RB1 (5.6% vs. 6.5%), MDM4 (6.2% vs. 5.7%), ATM (5.9% vs. 3.7%), MDM2 (7.4% vs. 4.1%), PIK3R1 (6.2% vs. 4.1%). There were no differences in frequency of mutations in these individual genes between males and females (χ 2 [1, N=585] = 0.05-2.86, p = 0.09-0.86). CONCLUSIONS Female sex is associated with improved survival. We did not identify sex-based differences in deleterious genomic alterations amongst commonly altered genes in GBM.

Download Full-text

Association of Surgical Resection, Disability, and Survival in Patients with Glioblastoma

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1685170 ◽

2019 ◽

Vol 80 (04) ◽

pp. 262-268 ◽

Cited By ~ 3

Author(s):

Yahya Ahmadipour ◽

Monika Kaur ◽

Daniela Pierscianek ◽

Oliver Gembruch ◽

Marvin Darkwah Oppong ◽

...

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Karnofsky Performance Status ◽

Performance Status ◽

Extent Of Resection ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Surgical Modality ◽

Supratotal Resection

Objective Extent of resection (EOR) and Karnofsky Performance Status (KPS) are at odds in glioblastoma (GBM) surgery, that is, the anticipated postoperative disability limits the EOR. This study analyzes the correlation of different surgical modalities with the resulting physical status and survival of patients with GBM. Methods A total of 565 patients with primary GBM were operated on in a single institution between 2006 and 2014. Possible surgical modalities comprised supratotal resection (SLR), gross total resection (GTR; ≥ 95% by volume), tumor debulking (TDB; ≤ 95% by volume), and stereotactic biopsy (SB). Pre- and postoperative KPS before and up to 4 weeks after surgery as well as overall survival (OS) rate were determined retrospectively. Hazard ratio (HR) and 95% confidence intervals were calculated using a Cox proportional hazards model. Results Median postoperative KPS was ≥ 70, irrespective of surgical modality. Mean OS was 12.5 months. Multivariate analysis revealed age ≥ 70 years (HR: 1.93), preoperative KPS < 70 (HR: 2.15), and unmethylation in MGMT promoter (HR: 1.27) as independent factors for worse OS. Regarding surgical modality, SB was associated with the worst survival (HR: 2.3) followed by TDB (HR: 1.36). SLR was inferior to GTR (HR: 1.27). Conclusion Higher EOR in patients with GBM does not seem inevitably correlated with increasing functional impairment, but better survival, provided there is a balanced preoperative indication. Nevertheless, SLR does not seem to be superior to GTR. Whenever possible, maximal safe resection should be considered in patients with GBM, even if an EOR ≥ 95% is not possible.

Download Full-text

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

Operative Neurosurgery ◽

10.1093/ons/opz203 ◽

2019 ◽

Cited By ~ 1

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.

Download Full-text

Comparative Analysis of Subventricular Zone Glioblastoma Contact and Ventricular Entry During Resection in Predicting Dissemination, Hydrocephalus, and Survival

Neurosurgery ◽

10.1093/neuros/nyz144 ◽

2019 ◽

Vol 85 (5) ◽

pp. E924-E932 ◽

Cited By ~ 5

Author(s):

Akshitkumar M Mistry ◽

Patrick D Kelly ◽

Jean-Nicolas Gallant ◽

Nishit Mummareddy ◽

Bret C Mobley ◽

...

Keyword(s):

Subventricular Zone ◽

Independent Predictor ◽

Karnofsky Performance Status ◽

Performance Status ◽

Extent Of Resection ◽

Outcome Analysis ◽

Leptomeningeal Dissemination ◽

Karnofsky Performance Status Score ◽

Radiation Treatments ◽

Distant Tumor

Abstract BACKGROUND Ventricular entry during glioblastoma resection and tumor contact with the subventricular zone (SVZ) have both been shown to associate with development of hydrocephalus, leptomeningeal dissemination, distant parenchymal recurrence, and decreased survival. However, prior studies did not analyze these variables together in a single-patient population; therefore, it is unknown which is an independent predictor of these outcomes. OBJECTIVE To conduct a comparative outcome analysis of surgical ventricular entry and SVZ contact by glioblastoma in a retrospective cohort of 232 patients. METHODS Outcomes studied included hydrocephalus, leptomeningeal dissemination, distant tumor recurrences, and progression-free (PFS) and overall (OS) survival. The Cox proportional regression analyses were adjusted for age at diagnosis, preoperative Karnofsky performance status score, extent of resection, temozolomide and radiation treatments, and tumor molecular status (specifically, IDH1/2 mutation and MGMT promoter methylation). RESULTS Surgical ventricular entry, SVZ-contacting glioblastoma, hydrocephalus, leptomeningeal dissemination, and distant recurrences were observed in 85 (36.6%), 114 (49.1%), 19 (8.2%), 78 (33.6%), and 59 (25.4%) patients, respectively. Multivariate, adjusted analysis revealed SVZ tumor contact—but not ventricular entry—associated with hydrocephalus (hazard ratio, HR, 4.20 [1.13-15.7], P = .03), leptomeningeal dissemination (HR 1.93 [1.14-3.28], P = .01), PFS (HR 2.10 [1.53-2.88], P < .001), and OS (HR 1.90 [1.35-2.67], P < .001). Distant recurrences were not associated with either. No interaction between the 2 variables was statistically noted. CONCLUSION SVZ contact by glioblastoma was independently associated with the development of hydrocephalus, leptomeningeal dissemination, and decreased survival. SVZ tumor contact was associated with ventricular entry during surgical resections, which did not independently correlate with these outcomes.

Download Full-text

Cranial Chordoma: A New Preoperative Grading System

Neurosurgery ◽

10.1093/neuros/nyx423 ◽

2017 ◽

Vol 83 (3) ◽

pp. 403-415 ◽

Cited By ~ 10

Author(s):

Harley Brito da Silva ◽

David Straus ◽

Jason K Barber ◽

Robert C Rostomily ◽

Manuel Ferreira ◽

...

Keyword(s):

Skull Base ◽

Tumor Recurrence ◽

Karnofsky Performance Status ◽

Performance Status ◽

Extent Of Resection ◽

Senior Author ◽

Successful Outcome ◽

Grading System ◽

Intermediate Risk ◽

Clivus Chordoma

Abstract BACKGROUND Chordomas are rare but challenging neoplasms involving the skull base. A preoperative grading system will be useful to identify both areas for treatment and risk factors, and correlate to the degree of resection, complications, and recurrence. OBJECTIVE To propose a new grading system for cranial chordomas designed by the senior author. Its purpose is to enable comparison of different tumors with a similar pathology to clivus chordoma, and statistically correlate with postoperative outcomes. METHODS The numerical grading system included tumor size, site of the tumor, vascular encasement, intradural extension, brainstem invasion, and recurrence of the tumor either after surgery or radiotherapy with a range of 2 to 25 points; it was used in 42 patients with cranial chordoma. The grading system was correlated with number of operations for resection, degree of resection, number and type of complications, recurrence, and survival. RESULTS We found 3 groups: low-risk 0 to 7 points, intermediate-risk 8 to 12 points, and high-risk ≥13 points in the grading system. The 3 groups were correlated with the following: extent of resection (partial, subtotal, or complete; P < .002); number of operative stages to achieve removal (P < .014); tumor recurrence (P = .03); postoperative Karnofsky Performance Status (P < .001); and with successful outcome (P = .005). The grading system itself correlated with the outcome (P = .005). CONCLUSION The proposed chordoma grading system can help surgeons to predict the difficulty of the case and know which areas of the skull base will need attention to plan further therapy.

Download Full-text

The effect of using awake craniotomy combined with multimodal techniques intraoperative on survival of patients with glioblastoma: a single-center experience

10.21203/rs.2.24046/v1 ◽

2020 ◽

Author(s):

hui zhou ◽

Li Yang ◽

Ming Lu ◽

Xqing Deng ◽

Mming Yang

Keyword(s):

Survival Time ◽

Parietal Lobe ◽

Karnofsky Performance Status ◽

Performance Status ◽

Intraoperative Ultrasound ◽

Extent Of Resection ◽

Awake Craniotomy ◽

Motor Dysfunction ◽

Tumour Resection ◽

Significant Difference

Abstract Background :We analysed outcomes of cerebral glioblastoma patients undergoing awake craniotomies combined with multimodal techniques for tumour resection, with regards to the extent of resection, functional preservation, and prognosis. Methods : A retrospective analysis was conducted on adult glioblastoma patients who underwent an awake craniotomy from September 2010 to August 2018 under anaesthesia combined with multimodal techniques. Results: In total, 81 glioblastoma patient charts were analysed. The most common lesion sites were the frontal lobe (n=36), temporal lobe (n=17), and parietal lobe (n=6). The main symptoms were headache (n=51), dyskinesia (n=11), speech disorder (n=9), and epilepsy (n=10). The extent of resection was gross total for 91.36% patients, subtotal for 7.41%, and partial for 1.23%. No deaths occurred 30 days post-operation. Intracranial haemorrhage occurred in 2 patients, seizures in 5 patients, and intracranial infections in 3 patients. There was no significant difference between preoperative and postoperative Karnofsky Performance Status scores (P>0.05). There were no significant changes in postoperative neurological function in 50 patients. Symptoms improved in 24 patients. Three patients exhibited motor dysfunction, 2 exhibited speech deficits, and 2 exhibited sensory deficits. The average duration of hospitalization was 6.89±2.66 days. The shortest survival time was 4 months, the longest survival time was 26 months, and the median survival time was 12 months. Conclusions: Awake craniotomy using multimodal techniques such as neuronavigation, intraoperative ultrasound, electrophysiology, and tumour fluorescence during an operation can maximize safety during the cerebral glioblastoma resection, thus protecting brain function and improving surgical efficacy and patients’ postoperative quality of life.

Download Full-text