scholarly journals Fluorescence-Guided Surgery and Biopsy in Gliomas with an Exoscope System

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
José Piquer ◽  
Jose L. Llácer ◽  
Vicente Rovira ◽  
Pedro Riesgo ◽  
Ruben Rodriguez ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Brain Biopsy ◽  
High Grade Glioma ◽  
Radical Resection ◽  
Histopathological Diagnosis ◽  
High Grade ◽  
Tumor Surgery ◽  
High Definition ◽  
Stereotactic Brain Biopsy ◽  
High Grade Astrocytoma

Background. The introduction of fluorescence-guided resection allows a better identification of tumor tissue and its more radical resection. We describe our experience with a modified exoscope to detect 5 ALA-induced fluorescence in neuronavigation-guided brain surgery or biopsy of malignant brain tumors.Methods. Thirty-eight patients with a suspected preoperative diagnosis of high-grade astrocytoma were included. We used a neuronavigation device and a high-definition exoscope system with a built-in filter to detect 5-ALA fluorescence in all cases. Thirty patients underwent craniotomy with tumor resection and 8 underwent frameless stereotactic brain biopsy.Results. Histopathological diagnosis confirmed the presence of high-grade gliomas in 34 patients. Total resection was achieved in 23 cases and subtotal in 7. No relevant complications related to the administration of 5-ALA were detected.Conclusions. The use of the exoscope in 5-ALA fluorescence-guided tumor surgery has twofold implications: during brain tumor surgery it can be considered a valuable tool to achieve a more radical resection of the lesion, and when applied to a biopsy of a suspected brain high-grade glioma, it decreases the possibility of a negative biopsy.

CTNI-41. INITIAL RESULTS OF A PHASE I WINDOW OF OPPORTUNITY TRIAL EVALUATING A FIRST-IN-CLASS CD29 INHIBITOR, OS2966, IN RECURRENT HIGH-GRADE GLIOMA

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi69-vi69
Author(s):  
James Liu ◽  
Chibueze D Nwagwu ◽  
Amanda V Immidisetti ◽  
Gabriela Bukanowska ◽  
Anne-Marie Carbonell ◽  
...  
Keyword(s):  
Adverse Events ◽  
Phase I ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Underlying Disease ◽  
Tissue Level ◽  
High Grade ◽  
Convection Enhanced Delivery ◽  
Tumor Biopsy ◽  
Safety Issues

Abstract BACKGROUND OS2966 is a first-in-class, humanized and deimmunized monoclonal antibody which antagonizes CD29/β1integrin, a mechanosignaling receptor prominently upregulated in glioblastoma. Preclinical studies in mice and non-human primates have demonstrated safety and encouraging efficacy. A two-part, ascending concentration, phase I clinical trial was therefore initiated to evaluate the safety and feasibility of delivering OS2966 directly to the site of disease via convection-enhanced delivery (CED) in recurrent high-grade glioma patients. METHODS This study has a 2-part design: In part 1, patients undergo stereotactic tumor biopsy followed by placement of a multiport CED catheter for delivery of OS2966 to the bulk contrast enhancing tumor. Subsequently, patients undergo a clinically-indicated tumor resection followed by placement of two CED catheters and delivery of OS2966 to the surrounding tumor-infiltrated brain. A unique concentration-based accelerated titration design is utilized for dose escalation. Given availability of pre and post infusion samples, pharmacodynamic data will be analyzed to explore mechanism of action of OS2966. RESULTS Two subjects have been treated at two corresponding dose levels (0.2mg/mL and 0.4 mg/mL). No dose-limiting toxicity or unexpected safety issues have been identified. To date, reported adverse events were mild (i.e., grade 1) and consistent with underlying disease and surgical procedures. No adverse events were attributed to OS2966 or CED catheter placement. Further, no clinically significant changes from baseline neurological exam have been noted for either patient through initial follow-up. Maximal tumor coverage and concomitant gross total resection were achieved for both patients. Tumor volume measured 1.63 cm3 and 16 cm3 for Patient 1 and 2 respectively with an intratumoral Vd/Vi ratio of 1.3. and 0.94. Pharmacodynamic analysis via tissue-level biomarkers is ongoing and will be presented. CONCLUSION Initial data demonstrates the safety and feasibility of direct intracranial delivery of OS2966.

Stereotactic Brain Biopsy in Eloquent Areas Assisted by Navigated Transcranial Magnetic Stimulation: a Technical Case Report

2018 ◽  
Vol 17 (3) ◽  
pp. E124-E129 ◽  
Author(s):  
Jiri Bartek ◽  
Gerald Cooray ◽  
Mominul Islam ◽  
Margret Jensdottir
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Awake Surgery ◽  
Histopathological Diagnosis ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Stereotactic Brain Biopsy ◽  
Eloquent Areas ◽  
The Brain

Abstract BACKGROUND AND IMPORTANCE Stereotactic brain biopsy (SB) is an important part of the neurosurgical armamentarium, with the possibility of achieving histopathological diagnosis in otherwise inaccessible lesions of the brain. Nevertheless, the procedure is not without the risk of morbidity, which is especially true for lesions in eloquent parts of the brain, where even a minor adverse event can result in significant deficits. Navigated transcranial magnetic stimulation (nTMS) is widely used to chart lesions in eloquent areas, successfully guiding maximal safe resection, while its potential role in aiding with the planning of a stereotactic biopsy is so far unexplored. CLINICAL PRESENTATION Magnetic resonance imaging of a 67-yr-old woman presenting with dysphasia revealed a noncontrast enhancing left-sided lesion in the frontal and parietal pars opercularis. Due to the location of the lesion, nTMS was used to chart both primary motor and language cortex, utilizing this information to plan a safe SB trajectory and sampling area according to the initial work-up recommendations from the multidisciplinary neuro-oncology board. The SB was uneventful, with histology revealing a ganglioglioma, WHO I. The patient was discharged the following day, having declined to proceed with tumor resection (awake surgery) due to the non-negligible risk of morbidity. Upon 1- and 3-mo follow-up, she showed no signs of any procedure-related deficits. CONCLUSION nTMS can be implemented to aid with the planning of a stereotactic biopsy procedure in eloquent areas of the brain, and should be considered part of the neurosurgical armamentarium.

scholarly journals Sodium Fluorescein for Spinal Intradural Tumors

2021 ◽  
Vol 10 ◽  
Author(s):  
Semih Kivanc Olguner ◽  
Ali Arslan ◽  
Vedat Açık ◽  
İsmail İstemen ◽  
Mehmet Can ◽  
...  
Keyword(s):  
Staining Pattern ◽  
Tumor Resection ◽  
Sodium Fluorescein ◽  
Histopathological Diagnosis ◽  
Tumor Surgery ◽  
Intramedullary Tumors ◽  
Fluorescein Staining ◽  
Yellow Filter ◽  
Intradural Tumor ◽  
Intradural Extramedullary

Technological innovations in spinal intradural tumor surgery simplify treatment. Surgical treatment of cranial benign and malignant pathologies under microscope with sodium (Na)-fluorescein guidance has often been reported, but few studies have focused on spinal intradural tumors. We aimed to investigate the usefulness of Na-fluorescein under yellow filter in intradural spinal tumor surgery by retrospectively reviewing cases involving intramedullary and extramedullary tumors operated under the guidance of Na-fluorescein. Forty-nine adult patients with a diagnosis of spinal intradural tumor operated under a yellow filter (560 nm) microscope using Na-fluorescein dye were included in the study. Demographic data, such as age and sex, neurological status, extent of tumor resection, histopathological diagnosis, Na-fluorescein staining pattern, and its usefulness during surgery were noted and statistically analyzed. Of all recruited patients, 26 women (53.1%) and 23 men (46.9%), were included for analysis. The age range of the patients was 18–64 years, with a mean age of 41.6 ± 13.9. An intradural intramedullary mass was found in 30.6% (n = 15) of the patients, and an intradural extramedullary mass in 69.4% (n: 34). While Na-fluorescein staining was homogeneous in all intradural extramedullary tumors, 73.3% (n: 11) of intradural intramedullary tumors were homogeneous, and 13.3% (n: 2) moderately heterogeneous. In the whole study group, the Na-fluorescein staining pattern was helpful in surgical resection in 47 cases (95.9%). While 34/34 (100%) found it helpful for extramedullary tumors, 13/15 (86.7%) did in intramedullary tumors, and for 2/15 (13.3%) it was not. In conclusion, Na-fluorescein helps in distinguishing tumor from healthy tissue in intradural extramedullary and intramedullary tumor surgery under a yellow filter microscope in most cases, thus providing convenient assistance to surgeons.

scholarly journals Effect of Anesthesia on The Outcome of High-Grade Glioma Patients Undergoing Supratentorial Resection: Study Protocol for A Randomized Controlled Trial 

2021 ◽  
Author(s):  
Dexiang Wang ◽  
Jia Dong ◽  
Min Zeng ◽  
Xiaoyuan Liu ◽  
Xiang Yan ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
High Grade ◽  
Intravenous Anesthesia ◽  
Inhalation Anesthesia ◽  
Randomized Controlled

Abstract Background High-grade glioma (HGG) is the most malignant brain tumor with poor outcome. Whether anesthetic methods have impact on the outcome of these patients is still unknown. Retrospective study has found that there is no difference between two anesthesia methods on the overall survival (OS), however, intravenous anesthesia with propofol might be beneficial in subgroup patients of KPS<80. Further prospective studies are needed to evaluate the results.Methods This is a single-centered, randomized controlled, parallel group trial. 196 patients with primary HGG for tumor resection will be randomly assigned to receive either the intravenous anesthesia with propofol or inhalation anesthesia with sevoflurane. The primary outcome is the OS within 18 months. Secondary outcomes include progression-free survival (PFS), the numerical rating scale (NRS) of pain intensity and sleep quality, the postoperative encephaloedema volume, complications, the length and cost effectiveness of hospital stay of the patients.Discussion This is a randomized controlled trial to compare the effect of intravenous or inhalation anesthesia maintenance on the outcome of supratentorial HGG patients.The results will help to optimizing the anesthesia methods in these patients.Trial registration: ClinicalTrials.gov (ID: NCT02756312). Registered on 27 April 2020 https://register.clinicaltrials.gov/

scholarly journals High-definition fiber tractography for the evaluation of perilesional white matter tracts in high-grade glioma surgery

2015 ◽  
pp. nov113 ◽  
Author(s):  
Kumar Abhinav ◽  
Fang-Cheng Yeh ◽  
Alireza Mansouri ◽  
Gelareh Zadeh ◽  
Juan C. Fernandez-Miranda
Keyword(s):  
White Matter ◽  
High Grade Glioma ◽  
High Grade ◽  
Fiber Tractography ◽  
High Definition ◽  
Glioma Surgery ◽  
White Matter Tracts

scholarly journals Well-Differentiated Extraskeletal Osteosarcoma Arising from the Retroperitoneum That Recurred as Anaplastic Spindle Cell Sarcoma

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Hiromasa Arai ◽  
Yasushi Rino ◽  
Teppei Nishii ◽  
Norio Yukawa ◽  
Nobuyuki Wada ◽  
...  
Keyword(s):  
Spindle Cell ◽  
Tumor Resection ◽  
Large Mass ◽  
Japanese Woman ◽  
Spindle Cell Sarcoma ◽  
Histopathological Diagnosis ◽  
High Grade ◽  
Extraskeletal Osteosarcoma ◽  
Cell Sarcoma ◽  
Well Differentiated

Extraskeletal osteosarcoma is an uncommon high-grade malignant soft tissue sarcoma. Well-differentiated extraskeletal osteosarcoma is thought to have a better prognosis than classical extraskeletal osteosarcoma, but dedifferentiation after recurrence has also been reported. We present a case of a primary retroperitoneal extraskeletal osteosarcoma in a 62-year-old Japanese woman. Abdominal CT revealed a large mass with diffuse calcification in the right retroperitoneal space and tumor resection was performed. The histopathological diagnosis was well-differentiated retroperitoneal extraskeletal osteosarcoma. She was followed up by CT every 6 months without adjuvant radiotherapy and chemotherapy for 31 months until anaplastic high-grade spindle cell sarcoma recurred in the retroperitoneum. Our case is the seventh reported description of well-differentiated extraskeletal sarcoma, and the first to arise in the retroperitoneum and recur as an entirely dedifferentiated spindle cell sarcoma.

scholarly journals Diagnostic Yield and Complication of Frameless Stereotactic Brain Biopsy

2019 ◽  
Vol 10 (01) ◽  
pp. 78-84 ◽  
Author(s):  
Chin Taweesomboonyat ◽  
Thara Tunthanathip ◽  
Sakchai Sae-Heng ◽  
Thakul Oearsakul
Keyword(s):  
Diagnostic Yield ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
High Grade Glioma ◽  
Intracerebral Hematoma ◽  
Low Grade ◽  
Essential Factor ◽  
Stereotactic Brain Biopsy ◽  
Intraoperative Bleeding ◽  
Positive Biopsy

Background: With the advancement of neuronavigation technologies, frameless stereotactic brain biopsy has been developed. Previous studies proved that frameless stereotactic brain biopsy was as effective and safe as frame-based stereotactic brain biopsy. The authors aimed to find the factors associated with diagnostic yield and complication rate of frameless intracranial biopsy. Materials and Methods: Frameless stereotactic brain biopsy procedures, between March 2009 and April 2017, were retrospectively reviewed from medical records including imaging studies. Using logistic regression analysis, various factors were analyzed for association with diagnostic yield and postoperative complications. Results: Eighty-nine frameless stereotactic brain biopsy procedures were performed on 85 patients. The most common pathology was primary central nervous system lymphoma (43.8%), followed by low-grade glioma (15.7%), and high-grade glioma (15%), respectively. The diagnostic yield was 87.6%. Postoperative intracerebral hematoma occurred in 19% of cases; however, it was symptomatic in only one case. The size of the lesion was associated with both diagnostic yield and postoperative intracerebral hematoma complication. Lesions, larger than 3 cm in diameter, were associated with a higher rate of positive biopsy result (P = 0.01). Lesion 3 cm or smaller than 3 cm in diameter, and intraoperative bleeding associated with a higher percentage of postoperative intracerebral hematoma complications (P = 0.01). Conclusions: For frameless stereotactic brain biopsy, the size of the lesion is the essential factor determining diagnostic yield and postoperative intracerebral hematoma complication.

scholarly journals 5-Aminolevulinic Acid–Protoporphyrin IX Fluorescence-Guided Surgery for CNS Tumors

2018 ◽  
Vol 27 (1) ◽  
pp. 13-19
Author(s):  
Ricardo Ramina ◽  
Erasmo Barros Da Silva Júnior ◽  
Maurício Coelho Neto ◽  
Leonardo Gilmone Ruschel ◽  
Felipe Andrés Constanzo Navarrette
Keyword(s):  
Aminolevulinic Acid ◽  
Protoporphyrin Ix ◽  
High Grade Glioma ◽  
Awake Surgery ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
High Grade ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
High Grade Gliomas

Introduction: In the last two decades the 5-aminolevulinic acid (5-ALA) has been utilized in primary brain lesions and metastases surgery to aid the identification of tumor limits and infiltration. Objectives: In this retrospective study, we demonstrate our experience with the first 41 cases Latin America of surgical resection of central nervous system (CNS) lesions with 5-ALA. Methods: In 41 consecutive patients, we recorded age, sex, histopathological diagnosis, intraoperative 5-ALA fluorescence tumor response, 5-ALA post-resection resection grade through magnetic resonance image (MRI) and other concomitantintra-operative techniques utilized (transoperative imaging, awake surgery, electrophysiological stimulation and monitoring). Results: Twenty seven high-grade gliomas and 4 non-glial lesions were 5-ALA fluorescence positive; 6 low-grade gliomas, 1 high-grade glioma and a hippocampal gliosis were 5-ALA fluorescence negative. In one case of a low-grade glioma, the patient developed a cardiac arrhythmia, probably not related to 5-ALA administration, but the surgery was suspended. Conclusions: 5-ALA fluorescence-guided surgery is a safe and easy technique to be used, increasing tumor total gross resection in glioma cases, proving to be an invaluable neurosurgical tool for intracranial tumor surgery. There was no serious side effect in this series. This dye should be utilized in all cases of high-grade gliomas. 

P14.51 Can patients with a suspected high-grade glioma receive tumor treatment during pregnancy safely?

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii47-ii47
Author(s):  
A N van der Vegt ◽  
R de Vries ◽  
J Osinga ◽  
N Grun ◽  
T J Postma ◽  
...  
Keyword(s):  
North America ◽  
Pregnant Women ◽  
Fetal Death ◽  
High Grade Glioma ◽  
Caesarian Section ◽  
Intrauterine Fetal Death ◽  
High Grade ◽  
Tumor Surgery ◽  
Tumor Treatment ◽  
Delivery Method

Abstract BACKGROUND Diagnosis of a glioma during pregnancy has ethical and medical dilemmas; treatment of the mother may harm the unborn child, but a too conservative approach towards tumor treatment can compromise the survival of the mother. In patients with a suspected high-grade glioma, postponing tumor treatment is undesirable. We collected published cases to describe the given treatments during pregnancy and the outcomes for mother and child. METHODS From Pubmed, Embase and Web of Science, 122 cases were extracted from 65 reports published between 1999 and 2020. We added 7 cases from our center. Cases came from: North-America (54/129), Europe (47/129), Asia (13/129), Middle-East (3/129) and one from Oceania and Africa each; 10 cases were from an unspecified country. The data were analysed with descriptive statistics. RESULTS The median age of the pregnant women was 30 (range 17–48) years; at the time of publication 42% of mothers had deceased. Most frequent symptoms at presentation were high intracranial pressure (35%), seizures (30%) or focal deficits (19%). Patients were diagnosed in each phase of the pregnancy - 30% in the first, 35% in the second and 35% in the last trimester. Twenty-two women decided to terminate the pregnancy (North America 9; Europe 9; international unspecified, Africa, Asia and Middle-East each one case). In sixty-seven percent of women, tumors were operated while pregnant, 70% of those were planned surgery, while in 30% surgery was in performed in an emergency setting. Most women received a resection. In 6 patients tumor surgery was combined with a caesarian section. Histological diagnosis of the tumor was available in 112 patients: anaplastic oligodendroglioma (n=10), anaplastic astrocytoma (n=30), glioblastoma (n=66) or high-grade glioma NOS (n=6). In 10 patients there was a suspected high grade glioma based on MRI imaging. Only 20 patients were treated after surgery whilst still pregnant with either radiotherapy (15/20, 75%), chemotherapy (2/20, 10%) or a combination of radiotherapy and chemotherapy (3/20, 15%) Other patients received additional treatment after delivery (109/129; 84%). Delivery method was a caesarian section in 60% and vaginal delivery in 21%- in 19% delivery method was not described. In 63% of cesarean sections were brought forward either because of rapid maternal deterioration or to enable maternal treatment after delivery. In 92% a healthy child was born, 7% had a intrauterine fetal death and 1% the child was stillborn. None of the patients who experienced intrauterine fetal death had received radio- or chemotherapy during pregnancy. CONCLUSIONS The majority of pregnant women continue their pregnancy when facing a diagnosis of a high grade glioma. Tumor surgery seemed safe during pregnancy. No adverse events were reported in the limited patients who received radiotherapy (n=15) during pregnancy. For chemotherapy we could not draw any conclusions.

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