Supratotal Resection of Periventricular Glioblastomas and Pathomorphological Rationale for Extensive Removal of Subventricular Zone

Abstract The aim of the research was to reveal the pathomorphological patterns of periventricular glioblastoma (PVG) dissemination and assess the rationale for extended surgical removal of subventricular zone (SVZ) as a step towards supratotal resection.A total of 54 patients (16 females and 38 males, mean age 48.9 ± 13.4 years, range 22–69) with PVG were prospectively included in the study. Standard preoperative evaluation included an MRI using 3D T1 with Gd-enhancement, T2, and T2-FLAIR series. The neuronavigation system was used to identify the SVZ and to remove of ventricular wall, additionally to image-guided total tumor resection. The pathomorphological assessment of PVG features with the description of the SVZ and changes in perifocal brain matter was performed by two pathologists.The median Karnofsky Performance Scale (KPS) score raised from 67.8 to 81.9 in the postoperative period. The overall median survival was 13.0 ± 2.7 months. The low postoperative KPS score (p = 0.05) and basal ganglia invasion (p = 0.008) significantly decreased survival rates.Microscopically, the typical multilayer structure of SVZ was disrupted. The invasive spread of tumor cells in thesubventricular space was identified. The ependymal layer had prominent dystrophic alterations of cells and destruction of intracellular connections. The hyperplastic reaction on neoplastic process was typical for adjacent ependyma.The pathomorphological identification of periventricular glioblastoma invasion in the subependymal space supports the supratotal tumor resection with removal of adjacent SVZ as a potential source for relapse.

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Preoperative Evaluation with fMRI of Patients with Intracranial Gliomas

Radiology Research and Practice ◽

10.1155/2012/727810 ◽

2012 ◽

Vol 2012 ◽

pp. 1-17 ◽

Cited By ~ 11

Author(s):

Ioannis Z. Kapsalakis ◽

Eftychia Z. Kapsalaki ◽

Efstathios D. Gotsis ◽

Dimitrios Verganelakis ◽

Panagiotis Toulas ◽

...

Keyword(s):

Preoperative Evaluation ◽

Tumor Resection ◽

Tumor Grade ◽

Functional Condition ◽

Extent Of Resection ◽

Cortical Mapping ◽

Karnofsky Performance Scale ◽

Language Mapping ◽

Motor Mapping ◽

Sensory Motor

Introduction. Aggressive surgical resection constitutes the optimal treatment for intracranial gliomas. However, the proximity of a tumor to eloquent areas requires exact knowledge of its anatomic relationships to functional cortex. The purpose of our study was to evaluate fMRI’s accuracy by comparing it to intraoperative cortical stimulation (DCS) mapping.Material and Methods. Eighty-seven patients, with presumed glioma diagnosis, underwent preoperative fMRI and intraoperative DCS for cortical mapping during tumor resection. Findings of fMRI and DCS were considered concordant if the identified cortical centers were less than 5 mm apart. Pre and postoperative Karnofsky Performance Scale and Spitzer scores were recorded. A postoperative MRI was obtained for assessing the extent of resection.Results. The areas of interest were identified by fMRI and DCS in all participants. The concordance between fMRI and DCS was 91.9% regarding sensory-motor cortex, 100% for visual cortex, and 85.4% for language. Data analysis showed that patients with better functional condition demonstrated higher concordance rates, while there also was a weak association between tumor grade and concordance rate. The mean extent of tumor resection was 96.7%.Conclusions. Functional MRI is a highly accurate preoperative methodology for sensory-motor mapping. However, in language mapping, DCS remains necessary for accurate localization.

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NI-01 Usefulness of preoperative evaluation of glioma elasticity by the magnetic resonance elastography

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa143.054 ◽

2020 ◽

Vol 2 (Supplement_3) ◽

pp. ii12-ii13

Author(s):

Shinichiro Koizumi ◽

Kazuhiko Kurozumi

Keyword(s):

Elastic Modulus ◽

Magnetic Resonance ◽

Preoperative Evaluation ◽

Tumor Resection ◽

High Grade Glioma ◽

Magnetic Resonance Elastography ◽

Low Grade ◽

Intracranial Tumors ◽

Grade 3 ◽

Malignant Grade

Abstract Introduction: The elasticity of intracranial tumors is difficult to assess non-invasively because the lesion is surrounded by the skull. Therefore, intracranial tumors have not been verified before surgery in terms of elastic modulus. Magnetic resonance elastography (MRE) is an epoch-making method capable of non-invasively imaging the elasticity of internal organs. We have examined the elasticity of meningiomas and pituitary adenomas and reported their usefulness. This time, we measured the glioma elasticity and verified usefulness of MRE. Method: Twenty-four gliomas (mean age 51.8±15.7 years, male: female = 17: 7) who underwent tumor resection after MRE imaging from July 2017 to May 2020 were targeted. The average elasticity was measured as an evaluation of tumor elastic modulus by MRE. Gliomas were divided into a low-grade glioma group (LGG: Grade 1, 2) and a high-grade glioma group (HGG: Grade 3, 4). Then, a comparative statistical study was conducted. Results: The average values of the average elasticity of LGG group (9 cases) and HGG group (15 cases) were 1.8±0.8 kPa and 2.5±0.8 kPa, respectively. The average elasticity was significantly higher in the HGG group (p=0.023). In the ROC analysis, the cutoff value was 2.1 kPa (sensitivity 70%, specificity 70%). Therefore, it was suggested that the tumor is likely to be HGG when the average elasticity is 2.1 kPa or more. Discussion: The glioma elasticity by preoperative MRE was significantly higher in the HGG group. Based on actual surgical experience, the tumor seems to be hard in the HGG group, and it was judged to be consistent with this our MRE research. The preoperative evaluation of glioma elasticity by MRE was considered useful, and it might help in planning a surgical strategy considering malignant grade.

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Malignant triton tumor of the left thoracic cavity: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz246 ◽

2019 ◽

Vol 2019 (8) ◽

Author(s):

Masashi Ishikawa ◽

Hiroyuki Chou ◽

Naoto Imamura ◽

Yumeta Shimazu ◽

Kazuo Ono

Keyword(s):

Tumor Resection ◽

Neurofibromatosis Type ◽

Large Mass ◽

Surgical Removal ◽

Thoracic Cavity ◽

Left Hemithorax ◽

Malignant Triton Tumor ◽

Nerve Sheath Tumors ◽

Peripheral Nerve Sheath Tumors ◽

Failure Investigation

Abstract Malignant triton tumor (MTT) is a rare subtype of malignant peripheral nerve sheath tumors with rhabdomyoblastic differentiation. Although the condition may manifest sporadically, it typically affects adult patients with neurofibromatosis type 1. In this article, an extremely rare case of MTT with chest wall origin, which expanded into the left thoracic cavity, is reported. A 64-year-old male was admitted to the institution with sudden shortness of breath. Radiological examination revealed a large mass with massive pleural effusion occupying the patient’s left hemithorax. A percutaneous needle biopsy was performed and the patient underwent subtotal tumor resection with left pleuropneumonectomy. Immunohistochemical study of postsurgical pathologic specimens confirmed the diagnosis of MTT. Despite extensive surgical removal, tumor recurrence was reported soon after resection, leading to patient’s death 20 days after surgery due to acute respiratory failure. Investigation of rare MTT cases is necessary for understanding this condition.

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Risk factors for wound-related reoperations in patients with metastatic spine tumor

Journal of Neurosurgery Spine ◽

10.3171/2017.10.spine1765 ◽

2018 ◽

Vol 28 (6) ◽

pp. 663-668 ◽

Cited By ~ 8

Author(s):

Hannah M. Carl ◽

A. Karim Ahmed ◽

Nancy Abu-Bonsrah ◽

Rafael De la Garza Ramos ◽

Eric W. Sankey ◽

...

Keyword(s):

Risk Factors ◽

Univariate Analysis ◽

Tumor Resection ◽

Multivariate Model ◽

Wound Complications ◽

Karnofsky Performance Scale ◽

Thromboembolic Events ◽

Spine Tumor ◽

Wound Breakdown ◽

Metastatic Spine Tumor

OBJECTIVEResection of metastatic spine tumors can improve patients’ quality of life by addressing pain or neurological compromise. However, resections are often complicated by wound dehiscence, infection, instrumentation failures, and the need for reoperation. Moreover, when reoperations are needed, the most common indication is surgical site infection and wound breakdown. In turn, wound reoperations increase morbidity as well as the length and cost of hospitalization. The aim of this study was to examine perioperative risk factors associated with increased rate of wound reoperations after metastatic spine tumor resection.METHODSA retrospective study of patients at a single institution who underwent metastatic spine tumor resection between 2003 and 2013 was conducted. Factors with a p value < 0.200 in a univariate analysis were included in the multivariate model.RESULTSA total of 159 patients were included in this study. Karnofsky Performance Scale score > 70, smoking status, hypertension, thromboembolic events, hyperlipidemia, increasing number of vertebral levels, and posterior approach were included in the multivariate analysis. Thromboembolic events (95% CI 1.19–48.5, p = 0.032) and number of levels involved were independently associated with increased wound reoperation rates in the multivariate model. For each additional spinal level involved, the risk for wound reoperations increased by 21% (95% CI 1.03–1.43, p = 0.018).CONCLUSIONSAlthough wound complications and subsequent reoperations are potential risks for all patients with metastatic spine tumor, due to adjuvant radiotherapy and other medical comorbidities, this study identified patients with thromboembolic events or those requiring a larger incision as being at the highest risk. Measures intended to decrease the occurrence of perioperative venous thromboembolism and to improve wound care, especially for long incisions, may decrease wound-related revision surgeries in this vulnerable group of patients.

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Preoperative evaluation of intraoperative blood loss during malignant soft tissue tumor resection by ultrasonography

Journal of Orthopaedic Science ◽

10.1016/j.jos.2017.12.011 ◽

2018 ◽

Vol 23 (2) ◽

pp. 403-407 ◽

Cited By ~ 2

Author(s):

Takeshi Morii ◽

Tomonori Kishino ◽

Naoko Shimamori ◽

Mitsue Motohashi ◽

Hiroaki Ohnishi ◽

...

Keyword(s):

Soft Tissue ◽

Blood Loss ◽

Soft Tissue Tumor ◽

Preoperative Evaluation ◽

Tumor Resection ◽

Intraoperative Blood Loss ◽

Tissue Tumor ◽

Malignant Soft Tissue Tumor ◽

Malignant Soft Tissue

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Role of Lymph Node Dissection in Primary Surgery for Thyroid Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2007.0053 ◽

2007 ◽

Vol 5 (6) ◽

pp. 623-630 ◽

Cited By ~ 22

Author(s):

Elizabeth G. Grubbs ◽

Douglas B. Evans

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Preoperative Evaluation ◽

Significant Risk ◽

Cervical Lymphadenopathy ◽

Operative Management ◽

Surgical Removal ◽

Cervical Lymph Nodes ◽

N0 Neck ◽

Preoperative Ultrasound

The preoperative evaluation of the clinically N0 neck and the operative management of cervical lymph nodes in patients with papillary and medullary thyroid cancer remains controversial. The appreciation that even patients with low-risk disease have a significant risk for recurrence has generated interest in a more comprehensive preoperative evaluation of the neck and has renewed debate on the extent of lymphadenectomy at the time of thyroidectomy. The authors recommend using preoperative ultrasound before thyroidectomy for all patients with thyroid cancer and before any subsequent surgeries for recurrent disease to identify the extent of lymph node metastases and thereby facilitate complete surgical removal of all gross disease in the neck. The optimal surgical procedure for removing cervical lymphadenopathy is compartment-oriented neck dissection based on the findings from preoperative ultrasound.

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Microsurgical Resection of an Intramedullary Spinal Cord Hemangioblastoma Through an Anterior Cervical Approach: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa314 ◽

2020 ◽

Author(s):

Kyle Lindsey McCormick ◽

Nikita Alexiades ◽

Paul C McCormick

Keyword(s):

Spinal Cord ◽

Tumor Resection ◽

Residual Tumor ◽

Complete Recovery ◽

Surgical Removal ◽

Intramedullary Spinal Cord ◽

Dural Closure ◽

Cervical Approach ◽

Anterior Cervical Approach ◽

Microsurgical Resection

Abstract This video demonstrates the microsurgical removal of an intramedullary spinal cord hemangioblastoma through an anterior cervical approach. While most spinal hemangioblastomas arise from the dorsal or dorsolateral pial surface and can be safely resected through a posterior approach,1,2 ventral tumors can present a significant challenge to safe surgical removal.3-5 This patient presented with a progressively symptomatic ventral pial based hemangioblastoma at the C5-6 level with large polar cysts extending from C3 to T1. The tumor was approached through a standard anterior cervical exposure with a C5 and C6 corpectomy. Following midline durotomy, the tumor was identified and complete microsurgical resection was achieved. The principles and techniques of tumor resection are illustrated and described in the video. Following tumor resection and dural closure, a fibular allograft was inserted into the corpectomy defect and a C4-C7 fixation plate was placed. The patient was maintained in a supine position for 36 h. He was discharged home on postoperative day 3 in a cervical collar. The patient did well with near-complete recovery of neurological function. Postoperative magnetic resonance imaging at 6 wk showed a substantial resolution of the polar cysts and no evidence of residual tumor. The patient featured in this video consented to the procedure.

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Intranasal proliferative fibro-osseous dysplasia in a domestic longhair cat

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116920917839 ◽

2020 ◽

Vol 6 (1) ◽

pp. 205511692091783

Author(s):

Clarisse D’Aout ◽

Helen Renfrew ◽

Melanie Dobromylskyj ◽

Nicholas Bacon ◽

Annika Herrmann ◽

...

Keyword(s):

Clinical Signs ◽

Definitive Diagnosis ◽

Surgical Removal ◽

Nasal Discharge ◽

Case Summary ◽

Post Procedure ◽

Osseous Dysplasia ◽

Histological Appearance ◽

Neoplastic Process ◽

Nasal Pathology

Case summary A 13-year-old female domestic longhair cat was presented for further investigation of chronic sneezing combined with a right-sided nasal discharge. A CT scan of the head revealed a locally invasive, aggressive right nasal mass radiographically consistent with a malignant neoplastic process. Histopathology on rhinoscopically guided biopsies revealed an unusual pathology consistent with fibro-osseous hyperplasia/dysplasia. Surgical treatment via a ventral rhinotomy and curettage was performed, and the diagnosis confirmed by repeat histopathology. The cat’s clinical signs significantly improved postoperatively. Relevance and novel information This case report describes an unusual feline nasal pathology. To our knowledge, there are no previous reports of a non-neoplastic, non-inflammatory expansile feline nasal tumour. Also described are the CT and histological appearance of the mass, and the difficulties encountered obtaining the definitive diagnosis. Information regarding the prognosis following surgical removal of proliferative fibro-osseous lesions in cats is poor, especially from the nasal cavity where clean margins may well be impossible to obtain. In this case, surgical resection improved clinical signs and the cat remains well at 15 months post-procedure.

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Extended transsphenoidal approach for pituitary adenomas invading the anterior cranial base, cavernous sinus, and clivus: a single-center experience with 126 consecutive cases

Journal of Neurosurgery ◽

10.3171/2009.3.jns0929 ◽

2010 ◽

Vol 112 (1) ◽

pp. 108-117 ◽

Cited By ~ 49

Author(s):

Bing Zhao ◽

Yu-Kui Wei ◽

Gui-Lin Li ◽

Yong-Ning Li ◽

Yong Yao ◽

...

Keyword(s):

Postoperative Complications ◽

Cavernous Sinus ◽

Pituitary Adenomas ◽

Tumor Resection ◽

Cranial Base ◽

Transsphenoidal Approach ◽

Preoperative Imaging ◽

Surgical Removal ◽

Extended Transsphenoidal Approach ◽

Anterior Cranial Base

Object The standard transsphenoidal approach has been successfully used to resect most pituitary adenomas. However, as a result of the limited exposure provided by this procedure, complete surgical removal of pituitary adenomas with parasellar or retrosellar extension remains problematic. By additional bone removal of the cranial base, the extended transsphenoidal approach provides better exposure to the parasellar and clival region compared with the standard approach. The authors describe their surgical experience with the extended transsphenoidal approach to remove pituitary adenomas invading the anterior cranial base, cavernous sinus (CS), and clivus. Methods Retrospective analysis was performed in 126 patients with pituitary adenomas that were surgically treated via the extended transsphenoidal approach between September 1999 and March 2008. There were 55 male and 71 female patients with a mean age of 43.4 years (range 12–75 years). There were 82 cases of macroadenoma and 44 cases of giant adenoma. Results Gross-total resection was achieved in 78 patients (61.9%), subtotal resection in 43 (34.1%), and partial resection in 5 (4%). Postoperative complications included transient cerebrospinal rhinorrhea (7 cases), incomplete cranial nerve palsy (5), panhypopituitarism (5), internal carotid artery injury (2), monocular blindness (2), permanent diabetes insipidus (1), and perforation of the nasal septum (2). No intraoperative or postoperative death was observed. Conclusions The extended transsphenoidal approach provides excellent exposure to pituitary adenomas invading the anterior cranial base, CS, and clivus. This approach enhances the degree of tumor resection and keeps postoperative complications relatively low. However, radical resection of tumors that are firm, highly invasive to the CS, or invading multidirectionally remains a big challenge. This procedure not only allows better visualization of the tumor and the neurovascular structures but also provides significant working space under the microscope, which facilitates intraoperative manipulation. Preoperative imaging studies and new techniques such as the neuronavigation system and the endoscope improve the efficacy and safety of tumor resection.

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Making the “inoperable” tumors “operable”: Harvey Cushing's contributions to the surgery of posterior fossa tumors

Neurosurgical FOCUS ◽

10.3171/2014.2.focus13580 ◽

2014 ◽

Vol 36 (4) ◽

pp. E15 ◽

Cited By ~ 3

Author(s):

Mahdi Malekpour ◽

Aaron A. Cohen-Gadol

Keyword(s):

Surgical Technique ◽

Posterior Fossa ◽

Preoperative Evaluation ◽

Pivotal Role ◽

Surgical Removal ◽

Posterior Fossa Surgery ◽

Posterior Fossa Tumors ◽

Harvey Cushing ◽

Ventricular Puncture

Harvey Cushing played a pivotal role in establishing neurosurgery as a distinct surgical discipline. One of his most important contributions was defining the surgical removal of posterior fossa tumors. Compulsive preoperative evaluation followed by meticulous surgical technique as well as incorporation of maneuvers such as ventricular puncture and electrocautery further advanced resection of tumors in this region. Herein, the authors review Cushing's contributions to posterior fossa surgery.

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