Intraventricular neuroepithelial tumors: Surgical outcome, technical considerations and review of literature

Abstract Background: Intraventricular neuroepithelial tumors (IVT) are rare lesions and comprise different pathological entities such as ependymomas, subependymomas and central neurocytomas. The treatment of choice is neurosurgical resection, which can be challenging due to their intraventricular location. Different surgical approaches to the ventricles are described. Here we report a large series of IVTs, its postoperative outcome at a single tertiary center and discuss suitable surgical approaches. Methods: We performed a retrospective chart review at a single tertiary neurosurgical center between 03/2009-05/2019. We included patients that underwent resection of an IVT emphasizing on surgical approach, extent of resection, clinical outcome and postoperative complications.Results: 45 IVTs were resected from 03/2009 to 05/2019, 13 ependymomas, 21 subependymomas, 10 central neurocytomas and one glioependymal cyst. Median age was 52,5 years with 55.6% (25) male and 44.4% (20) female patients. Gross total resection was achieved in 93.3% (42/45). 84.6% (11/13) of ependymomas, 100% (12/21) of subependymomas, 90% (9/10) of central neurocytomas and one glioependymal cyst were completely removed. Postoperative rate of new neurological deficits was 26.6% (12/45). Postoperative new permanent cranial nerve deficits occurred in one case with 4th ventricle subependymoma and one in 4th ventricle ependymoma. Postoperative KPSS was 90% (IR 80-100). 31.1% of the patients improved in KPSS, 48.9% remained unchanged and 20% declined. Postoperative adverse events rate was 20.0%. Surgery-related mortality was 2.2%. The rate of shunt/cisternostomy-dependent hydrocephalus was 13.3% (6/45). 15.4% of resected ependymomas underwent adjuvant radiotherapy. Mean follow-up was 26,9 (±30.1) months.Conclusion: Our surgical findings emphasize satisfactory complete resection throughout all entities. Surgical treatment can remain feasible, if institutional experience is given. Satisfying long-term survival and cure is possible by complete removal. Gross total resection should always be performed under function-remaining aspects due to mostly benign or slow growing nature of IVTs. Further data is needed to evaluate standard of care and alternative therapy options in rare cases of tumor recurrence or in case of patient collective not suitable for operative resection.

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Intraventricular neuroepithelial tumors: Surgical outcome, technical considerations and review of literature

10.21203/rs.3.rs-56348/v1 ◽

2020 ◽

Author(s):

Amir Kaywan Aftahy ◽

Melanie Barz ◽

Philipp Krauss ◽

Friederike Liesche ◽

Benedikt Wiestler ◽

...

Keyword(s):

Postoperative Outcome ◽

Gross Total Resection ◽

Neurological Deficits ◽

Surgical Approaches ◽

Total Resection ◽

Term Survival ◽

Neuroepithelial Tumors ◽

Glioependymal Cyst ◽

Tertiary Center ◽

4Th Ventricle

Abstract Background Intraventricular neuroepithelial tumors (IVT) are rare lesions and comprise different pathological entities such as ependymomas, subependymomas and central neurocytomas. The treatment of choice is neurosurgical resection, which can be challenging due to their intraventricular location. Different surgical approaches to the ventricles are described. Here we describe a large series of IVTs, its postoperative outcome at a single tertiary center and discuss suitable surgical approaches. Methods We performed a retrospective chart review at a single tertiary neurosurgical center between 03/2009-05/2019. We included patients that underwent resection of an IVT emphasizing on surgical approach, extent of resection, clinical outcome and postoperative complications. Results 45 IVTs were resected from 03/2009 to 05/2019, 13 ependymomas, 21 subependymomas, 10 central neurocytomas and one glioependymal cyst. Median age was 52,5 years with 55.6% (22) male and 44.4% (20) female patients. Gross total resection was achieved in 93.3% (42/45). 84.6% (11/13) of ependymomas, 100% (12/21) of subependymomas, 90% (9/10) of central neurocytomas and one glioependymal cyst were completely removed. Postoperative rate of new neurological deficits was 26.6% (12/45). Postoperative new permanent cranial nerve deficits occurred in one case with 4th ventricle subependymoma and one in 4th ventricle ependymoma. Postoperative KPSS was 90% (IR 80–100). 31.1% of the patients improved in KPSS, 48.9% remained unchanged and 20% declined. Postoperative adverse events rate was 20.0%. Surgery-related mortality was 2.2%. The rate of shunt/cisternostomy-dependent hydrocephalus was 13.3% (6/45). 15.4% of resected ependymomas underwent adjuvant radiotherapy. Mean follow-up was 26,9 (± 30.1) months. Conclusion Our surgical findings emphasize satisfactory complete resection throughout all entities. Surgical treatment can remain feasible, if institutional experience is given. Satisfying long-term survival and cure is possible by complete removal. Gross total resection should always be performed under function-remaining aspects due to mostly benign or slow growing nature of IVTs. Further data is needed to evaluate standard of care and alternative therapy options in rare cases of tumor recurrence or in case of patient collective not suitable for operative resection.

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Intraventricular neuroepithelial tumors: surgical outcome, technical considerations and review of literature

BMC Cancer ◽

10.1186/s12885-020-07570-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

A. Kaywan Aftahy ◽

Melanie Barz ◽

Philipp Krauss ◽

Friederike Liesche ◽

Benedikt Wiestler ◽

...

Keyword(s):

Postoperative Outcome ◽

Gross Total Resection ◽

Neurological Deficits ◽

Surgical Approaches ◽

Total Resection ◽

Term Survival ◽

Neuroepithelial Tumors ◽

Glioependymal Cyst ◽

Tertiary Center ◽

4Th Ventricle

Abstract Background Intraventricular neuroepithelial tumors (IVT) are rare lesions and comprise different pathological entities such as ependymomas, subependymomas and central neurocytomas. The treatment of choice is neurosurgical resection, which can be challenging due to their intraventricular location. Different surgical approaches to the ventricles are described. Here we report a large series of IVTs, its postoperative outcome at a single tertiary center and discuss suitable surgical approaches. Methods We performed a retrospective chart review at a single tertiary neurosurgical center between 03/2009–05/2019. We included patients that underwent resection of an IVT emphasizing on surgical approach, extent of resection, clinical outcome and postoperative complications. Results Forty five IVTs were resected from 03/2009 to 05/2019, 13 ependymomas, 21 subependymomas, 10 central neurocytomas and one glioependymal cyst. Median age was 52,5 years with 55.6% (25) male and 44.4% (20) female patients. Gross total resection was achieved in 93.3% (42/45). 84.6% (11/13) of ependymomas, 100% (12/21) of subependymomas, 90% (9/10) of central neurocytomas and one glioependymal cyst were completely removed. Postoperative rate of new neurological deficits was 26.6% (12/45). Postoperative new permanent cranial nerve deficits occurred in one case with 4th ventricle subependymoma and one in 4th ventricle ependymoma. Postoperative KPSS was 90% (IR 80–100). 31.1% of the patients improved in KPSS, 48.9% remained unchanged and 20% declined. Postoperative adverse events rate was 20.0%. Surgery-related mortality was 2.2%. The rate of shunt/cisternostomy-dependent hydrocephalus was 13.3% (6/45). 15.4% of resected ependymomas underwent adjuvant radiotherapy. Mean follow-up was 26,9 (±30.1) months. Conclusion Our surgical findings emphasize satisfactory complete resection throughout all entities. Surgical treatment can remain feasible, if institutional experience is given. Satisfying long-term survival and cure is possible by complete removal. Gross total resection should always be performed under function-remaining aspects due to mostly benign or slow growing nature of IVTs. Further data is needed to evaluate standard of care and alternative therapy options in rare cases of tumor recurrence or in case of patient collective not suitable for operative resection.

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Stereotactic Volumetric Resection of Thalamic Pilocytic Astrocytomas

Neurosurgery ◽

10.1227/01.neu.0000279725.13521.a3 ◽

2007 ◽

Vol 61 (1) ◽

pp. 66-75 ◽

Cited By ~ 47

Author(s):

Yaron A. Moshel ◽

Michael J. Link ◽

Patrick J. Kelly

Keyword(s):

New York ◽

Residual Tumor ◽

Gross Total Resection ◽

Neurological Deficits ◽

Surgical Approaches ◽

New York University ◽

Total Resection ◽

Pilocytic Astrocytomas

Abstract OBJECTIVE To describe the surgical approaches, the radiographic and clinical outcomes, and the long-term follow-up of patients harboring thalamic pilocytic astrocytomas after radical resection by means of a stereotactic volumetric technique. METHODS Seventy-two patients with thalamic pilocytic astrocytomas underwent stereotactic volumetric resection by the senior author (PJK) at the Mayo Clinic between 1984 and 1993 (44 patients) and at New York University Medical Center between 1993 and 2005 (28 patients). Patient demographics, presenting symptoms, surgical approaches, neurological outcomes, pathology, initial postoperative status, and long-term clinical and radiographic follow-up were retrospectively reviewed. RESULTS On preoperative neurological examinations, 54 of the 72 patients had neurological deficits; of these, 48 had hemiparesis. Postoperative imaging demonstrated gross total resection in 58 patients and minimal (<6 mm) residual tumor in 13 patients. Tumor resection was aborted in one patient. On immediate postoperative examination, 16 patients had significant improvements in hemiparesis. Six patients had worsening of a preexisting hemiparesis and one had a new transient postoperative hemiparesis. There was one postoperative death. After 13 to 20 years of follow-up in the Mayo group (mean, 15 ± 3 yr) and 1 to 13 years of follow-up in the New York University group (mean, 8 ± 3 yr), 67 patients were recurrence/progression-free, one had tumor recurrence, and three had progression of residual tumor. There were two shunt-related deaths. On long-term neurological follow-up, 27 patients had significant improvements in hemiparesis; one patient with a postoperative worsening of a preexisting hemiparesis remained unchanged. There were no patients with new long-term motor deficits after stereotactic resection. CONCLUSION Gross total removal of thalamic pilocytic astrocytomas with low morbidity and mortality can be achieved by computer-assisted stereotactic volumetric resection techniques. Gross total resection of these lesions confers a favorable long-term prognosis without adjuvant chemotherapy and/or radiation therapy and leads to the improvement of neurological deficits.

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Sodium Fluorescein-Guided Gross Total Resection of Pediatric Exophytic Brainstem Glioma: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa357 ◽

2020 ◽

Author(s):

Christopher Markosian ◽

Catherine A Mazzola ◽

Luke D Tomycz

Keyword(s):

Normal Tissue ◽

Clinical Case ◽

Aminolevulinic Acid ◽

Significant Risk ◽

Gross Total Resection ◽

Subtotal Resection ◽

Sodium Fluorescein ◽

Total Resection ◽

Term Survival ◽

Patient Consent

Abstract Brainstem gliomas comprise 10% to 20% of pediatric intracranial tumors.1 Gross total resection is associated with the greatest long-term survival.1 However, due to the eloquence of surrounding brain tissue, an aggressive resection is not always achievable and can be associated with significant risk.2 Sodium fluorescein can be used to help differentiate between tumor and normal tissue.3,4 In this operative video, we demonstrate the step-by-step technique to utilize fluorescence in surgically resecting an exophytic glioma arising from the midbrain in a 16-yr-old male. Technical nuances are highlighted in this operative video, including the use of the YELLOW 560 (Zeiss) filter to differentiate fluorescent tumor from normal tissue as well as strategic splitting of the tentorium to expose the supratentorial component of the tumor. A decrease in motor potentials of the right leg during the case did not translate into neurological worsening postoperatively; at 3-mo follow-up, the patient attests to better strength and coordination on his affected side. In summary, sodium fluorescein can be used as a critical adjunctive tool for successful surgery in the case of a brainstem tumor. Alternatives to this procedure included gross total resection with 5-aminolevulinic acid, subtotal resection with chemotherapy, and active monitoring, but were not chosen due to their limitations in this clinical case.5-7 Appropriate patient consent was obtained to perform this procedure and present this clinical case and surgical video for academic purposes.

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Clinical, surgical and postoperative outcome analysis of tumors occupying both posterior and middle cranial fossa

Nepal Journal of Neuroscience ◽

10.3126/njn.v18i2.33783 ◽

2021 ◽

Vol 18 (2) ◽

pp. 36-44

Author(s):

Rahul Singh ◽

Ravi Shankar Prasad ◽

Ramit Chandra Singh ◽

Kulwant Singh ◽

Anurag Sahu

Keyword(s):

Postoperative Outcome ◽

Middle Cranial Fossa ◽

Posterior Cranial Fossa ◽

Gross Total Resection ◽

Outcome Analysis ◽

Subtotal Resection ◽

Combined Approach ◽

Total Resection ◽

Trigeminal Schwannoma ◽

Cranial Fossa

Objectives: To analyse clinical, surgical and postoperative outcome perspectives of tumors occupying both middle and posterior cranial fossa. Materials and Methods: This retrospective cohort study includes 23 patients operated for tumors involving both middle and posterior cranial fossa in our department between August 2016 and August 2020. Each patient was evaluated for age, sex, co morbidities, tumour histopathology, clinical presentation, radiological characteristics, surgical and outcome characteristics. Unpaired t- test and chi-square test was used for statistical analysis. P < 0.05 was considered statistically significant. Results: The mean age was 46 years (range 40–57 years), with the majority of patients being female (56.5%). Most tumors (65.3%) were trigeminal schwannoma, with the remaining being vestibular schwannoma (21.7%), facial schwannoma (8.7%) and epidermoid (4.3%). The most commonly used surgical approach was the retrosigmoid approach (30.4%) and combined approach (30.4%). Gross total resection (GTR) was done in 14 patients while subtotal resection (STR) was done in 9 patients. STR was significantly associated (p<0.05) with persisting cranial nerve deficit and tumour progression. Midbrain compression, internal carotid artery and cavernous sinus involvement were significantly (p<0.05) associated with STR. Conclusions: Trigeminal schwannoma is the most common tumour involving both middle and posterior cranial fossa. Combined approach for such tumours is required in tumours having significant size in both middle cranial fossa and posterior cranial fossa. The intent of surgery is to achieve a gross total resection (GTR) but adhesions and involvement of critical brain structures results in STR.

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Gross total resection of intracisternal accessory nerve schwannomas using a familiar midline suboccipital subtonsilar approach

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz220 ◽

2019 ◽

Vol 2019 (7) ◽

Author(s):

Elias Antoniades ◽

Alkinoos Athanasiou ◽

Panagiotis Sarlis ◽

Ioannis Magras ◽

Ioannis Patsalas

Keyword(s):

Relevant Literature ◽

Accessory Nerve ◽

Gross Total Resection ◽

Neurological Deficits ◽

Cerebrospinal Fluid Leakage ◽

Spinal Root ◽

Total Resection ◽

Suboccipital Craniotomy ◽

Rare Lesion ◽

Chronic Headaches

Abstract Background Intracisternal Accessory Nerve Schwannomas (ANS) constitute a rare clinical entity with only a few cases reported so far. Their symptoms are usually due to brainstem compression and not manifested until they render of great size. Secondary neuropathy and muscle atrophy are other late signs. The hitherto reported literature advocates a suboccipital craniotomy as a suitable approach. In most of the cases the spinal root was the location tumor arose from. Gross total resection was possible to be carried out in most cases with only sporadic tolerable postoperative deficits reported. Case description We hereby present three cases of patients with intracisternal ANS treated in the same fashion. Two patients were male and one female. Two patients complained of mainly chronic headaches and neck pain, whereas in the third patient the lesion was found incidentally. Only one patient suffered post-operatively cerebrospinal fluid leakage and wound healing complication, which was treated with revision surgery and administration of antibiotics. None of the patients had postoperative neurological deficits. Furthermore, we conducted a review of the relevant literature where we noted that there is no consensus yet with regards to the appropriate surgical approach. Conclusions Based on relevant anatomical studies, we advocate that suboccipital subtonsilar approach provides a wide corridor to the area of lesion allowing complete and safe resection of intracisternal ANS. We thus support that, in most cases, the neurosurgeon should consider using this familiar approach for treating this rare lesion.

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Individualized surgical strategies for Rathke cleft cyst based on cyst location

Journal of Neurosurgery ◽

10.3171/2013.8.jns13777 ◽

2013 ◽

Vol 119 (6) ◽

pp. 1437-1446 ◽

Cited By ~ 9

Author(s):

Jun Fan ◽

Yuping Peng ◽

Songtao Qi ◽

Xi-an Zhang ◽

Binghui Qiu ◽

...

Keyword(s):

Extent Of Resection ◽

Gross Total Resection ◽

Surgical Approaches ◽

Subtotal Resection ◽

Total Resection ◽

Surgical Strategies ◽

Minimal Invasiveness ◽

Rathke Cleft Cyst ◽

Csf Leakage ◽

Keyhole Craniotomy

Object An assessment regarding both surgical approaches and the extent of resection for Rathke cleft cysts (RCCs) based on their locations has not been reported. The aim of this study was to report the results of a large series of surgically treated patients with RCCs and to evaluate the feasibility of individualized surgical strategies for different RCCs. Methods We retrospectively reviewed 87 cases involving patients with RCCs (16 intrasellar, 50 intra- and suprasellar, and 21 purely suprasellar lesions). Forty-nine patients were treated via a transsphenoidal (TS) approach, and 38 were treated via a transcranial (TC) approach (traditional craniotomy in 21 cases and supraorbital keyhole craniotomy in 17). The extent of resection was classified as gross-total resection (GTR) or subtotal resection (STR) of the cyst wall. Patients were thus divided into 3 groups according to the approach selected and the extent of resection: TS/STR (n = 49), TC/STR (n = 23), and TC/GTR (n = 15). Results Preoperative headaches, visual dysfunction, hypopituitarism, and diabetes insipidus (DI) resolved in 85%, 95%, 55%, and 65% of patients, respectively. These rates did not differ significantly among the 3 groups. Overall, complications occurred in 8% of patients in TS/STR group, 9% in TC/STR group, and 47% in TC/GTR group, respectively (p = 0.002). Cerebrospinal fluid (CSF) leakage (3%), new hypopituitarism (9%), and DI (6%) were observed after surgery. All CSF leaks occurred in the endonasal group, while the TC/GTR group showed a higher rate of postoperative hypopituitarism (p = 0.7 and p < 0.001, respectively). It should be particularly noted that preoperative hypopituitarism and DI returned to normal, respectively, in 100% and 83% of patients who underwent supraorbital surgery, and with the exception of 1 patient who had transient postoperative DI, there were no complications in patients treated with supraorbital surgery. Kaplan-Meier 3-year recurrence-free rates were 84%, 87%, and 86% in the TS/STR, TC/STR, and TC/GTR groups, respectively (p = 0.9). Conclusions It is reasonable to adopt individualized surgical strategies for RCCs based on cyst location. Gross-total resection does not appear to reduce the recurrence rate but increase the risk of postoperative complications. The endonasal approach seems more appropriate for primarily intrasellar RCCs, while the craniotomy is recommended for purely or mainly suprasellar cysts. The supraorbital route appears to be preferred over traditional craniotomy for its minimal invasiveness and favorable outcomes. The endoscopic technique is helpful for either endonasal or supraorbital surgery.

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Cardiac phoenix in the brain-occult intracranial hemorrhagic metastases from completely resected atrial myxoma

Surgical Neurology International ◽

10.25259/sni_410_2020 ◽

2020 ◽

Vol 11 ◽

pp. 383

Author(s):

Sagar Amrutlal Ghodasara ◽

Rohit Balasubramanian ◽

Shriram Varadharajan ◽

P. S. Shobhanaa

Keyword(s):

Cerebral Cortex ◽

Cardiac Myxoma ◽

Surgical Excision ◽

Atrial Myxoma ◽

Gross Total Resection ◽

Neurological Deficits ◽

Surgical Removal ◽

Early Recovery ◽

Total Resection ◽

Tumor Embolization

Background: Cardiac myxomas are sporadic in nature and can often recur with a frequency of 3%, especially in middle-aged women, and 22% of the cases account to a part of Carney complex. Complete surgical removal of the myxoma is usually curative. Recurrence has been related with partial surgical excision, multicentricity, and embolism of tumor fragments. Case Description: We report a case of a patient with single brain metastases due to tumor embolization, from a cardiac myxoma operated prior. This case is exclusive, as tumor embolization from atrial myxoma to the cerebral cortex can be possible, within a short duration. In our case, the patient was evaluated with a magnetic resonance imaging brain and a solitary hemorrhagic lesion in the eloquent cerebral cortex was observed. To determine the primary etiology, the diagnosis of probable metastases was thought of, and a thorough workup was planned. Surprisingly, no primary lesion was detected, and as a histological diagnosis was required, he underwent a navigation-guided excisional biopsy of lesion. The biopsy was indicative of a metastatic deposit from an atrial myxoma. Conclusion: In eloquent cortex lesions, gross total resection is challenging for a neurosurgeon especially when the patient has no significant neurological deficits. Timely gross total resection of a solitary metastatic lesion can improve the patient’s outcome and can enhance early recovery with less or no morbidity.

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P.124 Meta-analysis comparing predictors of good postoperative seizure control in children with dysembryoplastic neuroepithelial tumors and gangliogliomas

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.223 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S48-S49

Author(s):

A Ranger ◽

D Diosy

Keyword(s):

Meta Analysis ◽

Gross Total Resection ◽

Seizure Freedom ◽

Tumor Type ◽

Total Resection ◽

Neuroepithelial Tumors ◽

Dysembryoplastic Neuroepithelial Tumors ◽

Not Otherwise Specified ◽

Age At Surgery ◽

Postoperative Seizure

Background: Dysembryoplastic neuroepithelial tumors (DNETs) and gangliogliomas are the most common cause of tumor-related seizures in children and adolescents. Little is known about predictors of surgical success, in terms of seizure freedom. All relevant papers since 1995 were identified. Methods: Over 4000 abstracts were screened on MedLine to identify data comparing tumor type (DNET vs. ganglioglioma) and predictors of post-operative seizure freedom. Results: Seventeen papers were identified encompassing 97 DNET and 95 ganglioglioma patients. Fifteen patients were found with other neuroglial tumors (NGT) or NGT not-otherwise-specified. DNET patients were found to have less frequent seizures, more likely to have second lobe involvement, and to achieve gross total resection. Seizure freedom was achieved in roughly 80% of patients, with no distinction by tumor type, with no surgery-related or peri-operative deaths. For DNETs, seizure freedom was associated with shorter seizure duration, simple lesionectomy, gross total resection, and shorter duration of follow-up. In ganglioglioma patients, seizure freedom was associated with younger age at surgery, secondary generalization (unexpectedly), absence of dysplasia, and gross total resection. Gross total resection was the strongest predictor. Conclusions: Epilepsy surgery for DNET and ganglioglioma had similar outcomes with gross total resection being the strongest predictor.

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Gross Total Resection Rates in Contemporary Glioblastoma Surgery

Neurosurgery ◽

10.1227/neu.0b013e31826d1e6b ◽

2012 ◽

Vol 71 (5) ◽

pp. 927-936 ◽

Cited By ~ 120

Author(s):

Philippe Schucht ◽

Jürgen Beck ◽

Janine Abu-Isa ◽

Lukas Andereggen ◽

Michael Murek ◽

...

Keyword(s):

Aminolevulinic Acid ◽

Complete Resection ◽

High Rate ◽

Gross Total Resection ◽

Neurological Deficits ◽

Total Resection ◽

Glioma Surgery ◽

Intraoperative Mapping ◽

Number Of Patients ◽

The Impact

Abstract BACKGROUND: Complete resection of contrast-enhancing tumor has been recognized as an important prognostic factor in patients with glioblastoma and is a primary goal of surgery. Various intraoperative technologies have recently been introduced to improve glioma surgery. OBJECTIVE: To evaluate the impact of using 5-aminolevulinic acid and intraoperative mapping and monitoring on the rate of complete resection of enhancing tumor (CRET), gross total resection (GTR), and new neurological deficits as part of an institutional protocol. METHODS: One hundred three consecutive patients underwent resection of glioblastoma from August 2008 to November 2010. Eligibility for CRET was based on the initial magnetic resonance imaging assessed by 2 reviewers. The primary end point was the number of patients with CRET and GTR. Secondary end points were volume of residual contrast-enhancing tissue and new postoperative neurological deficits. RESULTS: Fifty-three patients were eligible for GTR/CRET (n = 43 newly diagnosed glioblastoma, n = 10 recurrent); 13 additional patients received surgery for GTR/CRET-ineligible glioblastoma. GTR was achieved in 96% of patients (n = 51, no residual enhancement > 0.175 cm3); CRET was achieved in 89% (n = 47, no residual enhancement). Postoperatively, 2 patients experienced worsening of preoperative hemianopia, 1 patient had a new mild hemiparesis, and another patient sustained sensory deficits. CONCLUSION: Using 5-aminolevulinic acid imaging and intraoperative mapping/monitoring together leads to a high rate of CRET and an increased rate of GTR compared with the literature without increasing the rate of permanent morbidity. The combination of safety and resection-enhancing intraoperative technologies was likely to be the major drivers for this high rate of CRET/GTR.

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