SURG-05. NAVIGATED INTRA-OPERATIVE 2-D ULTRASOUND VS STANDARD NEURONAVIGATION IN HIGH GRADE GLIOMA SURGERY

Maximal safe resection is the primary goal of glioma surgery. By incorporating improved intraoperative visualization with the 3D exoscope combined with 5-ALA fluorescence, in addition to neuronavigation and diffusion tensor imaging (DTI) fiber tracking, the safety of resection of tumors in eloquent brain regions can be maximized. This video highlights some of the various intraoperative adjuncts used in brain tumor surgery for high-grade glioma. In this case, the authors highlight the resection of a left posterior temporal lobe high-grade glioma in a 33-year-old patient, who initially presented with seizures, word-finding difficulty, and right-sided weakness. They demonstrate the multiple surgical adjuncts used both before and during surgical resection, and how multiple adjuncts can be effectively orchestrated to make surgery in eloquent brain areas safer for patients. Patient consent was obtained for publication. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21174

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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.

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Optimizing the extent of resection and minimizing the morbidity in insular high-grade glioma surgery by high-field intraoperative MRI guidance

Turkish Neurosurgery ◽

10.5137/1019-5149.jtn.18346-16.1 ◽

2016 ◽

Cited By ~ 2

Author(s):

Chen Li-feng ◽

Yang Yang ◽

Ma Xiao-dong ◽

Yu Xin-guang ◽

Gui Qiu-ping ◽

...

Keyword(s):

High Field ◽

High Grade Glioma ◽

Extent Of Resection ◽

Intraoperative Mri ◽

High Grade ◽

Glioma Surgery ◽

Mri Guidance

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Low-Cost Fluorescein Detection System for High-Grade Glioma Surgery

World Neurosurgery ◽

10.1016/j.wneu.2016.01.017 ◽

2016 ◽

Vol 88 ◽

pp. 54-58 ◽

Cited By ~ 20

Author(s):

Daniele Bongetta ◽

Cesare Zoia ◽

Raffaelino Pugliese ◽

Daniela Adinolfi ◽

Vittorio Silvani ◽

...

Keyword(s):

Detection System ◽

Low Cost ◽

High Grade Glioma ◽

High Grade ◽

Glioma Surgery

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Cancer Dissemination, Hydrocephalus, and Survival After Cerebral Ventricular Entry During High-Grade Glioma Surgery: A Meta-Analysis

Neurosurgery ◽

10.1093/neuros/nyy202 ◽

2018 ◽

Cited By ~ 1

Author(s):

Akshitkumar M Mistry ◽

Patrick D Kelly ◽

Reid C Thompson ◽

Lola B Chambless

Keyword(s):

Meta Analysis ◽

High Grade Glioma ◽

High Grade ◽

Glioma Surgery ◽

Cancer Dissemination

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

Neuro-Oncology ◽

10.1093/neuonc/noz175.1018 ◽

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.

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