scholarly journals Extent of Glioma Resection on Intraoperative Ultrasound Correlates Well with Postoperative MRI Results

2019 ◽  
pp. 1-7
Author(s):  
Ahmed Aly ◽  
Radwan Noubi ◽  
Mahmoud Ragab ◽  
Khalid Abdelaziz ◽  
Simon Howarth ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Intraoperative Imaging ◽  
Intraoperative Ultrasound ◽  
Extent Of Resection ◽  
Control Group ◽  
P Value ◽  
Low Grade ◽  
Ultrasound Images ◽  
Glioma Surgery ◽  
Number Of Patients

Background: Maximal surgical resection is thought to confer survival benefit for both high- and low-grade gliomas. Intraoperative imaging assists with achieving maximal surgical resection. Different intraoperative imaging modalities have been implemented, but intra-operative MRI has a high cost that may limit its uptake in resource scarce healthcare systems. Objectives: This study aims to evaluate intraoperative ultrasound as a surrogate for intra and post-operative MRI for assessing the extent of resection of glioma. Methods: A partially prospective comparative study, which compares a prospective cohort group with a historical control group. We evaluated 74 glioma patients, who all underwent surgery in a regional UK Neurosurgical centre between October 2013 and October 2017. The study population was divided into 2 groups based on the use of ultrasound to guide the resection. We compared the size of the lesion prior and after excision to evaluate the extent of resection and undertook comparison with post-operative MRI. Results: The mean extent of resection on the ultrasound images was 96.1 % and 97.7 % on the postoperative MR. Using Spearman’s correlation; extent of resection on the ultrasound images was strongly correlated with the extent of resection on the postoperative MR images (P=value <0.001). The use of intraoperative ultrasound was associated with a significant increase in the number of patients in whom 95% or greater extent of resection was achieved (Fisher’s exact test P= value 0.033). Conclusion: Intra-operative ultrasonography could provide a reliable and cheaper alternative to intraoperative MRI to improve the extent of resection in glioma surgery.

scholarly journals Association of single-nucleotide polymorphisms in the ESR2 and FSHR genes with poor ovarian response in infertile Jordanian women

2021 ◽  
Vol 48 (1) ◽  
pp. 69-79
Author(s):  
Amer Mahmoud Sindiani ◽  
Osamah Batiha ◽  
Esra’a Al-zoubi ◽  
Sara Khadrawi ◽  
Ghadeer Alsoukhni ◽  
...  
Keyword(s):  
Single Nucleotide Polymorphisms ◽  
Statistical Significance ◽  
Ovarian Response ◽  
Control Group ◽  
P Value ◽  
Case Group ◽  
Nucleotide Polymorphisms ◽  
Poor Ovarian Response ◽  
Single Nucleotide ◽  
Number Of Patients

Objective: Poor ovarian response (POR) refers to a subnormal follicular response that leads to a decrease in the quality and quantity of the eggs retrieved after ovarian stimulation during assisted reproductive treatment (ART). The present study investigated the associations of multiple variants of the estrogen receptor 2 (ESR2) and follicle-stimulating hormone receptor (FSHR) genes with POR in infertile Jordanian women undergoing ART.Methods: Four polymorphisms, namely ESR2 rs1256049, ESR2 rs4986938, FSHR rs6165, and FSHR rs6166, were investigated in 60 infertile Jordanian women undergoing ART (the case group) and 60 age-matched fertile women (the control group), with a mean age of 33.60±6.34 years. Single-nucleotide polymorphisms (SNPs) were detected by restriction fragment length polymorphism and then validated using Sanger sequencing.Results: The p-value of the difference between the case and control groups regarding FSHR rs6166 was very close to 0.05 (p=0.054). However, no significant differences were observed between the two groups in terms of the other three SNPs, namely ESR2 rs1256049, ESR2 rs4986938, and FSHR rs6165 (p=0.561, p=0.433, and p=0.696, respectively).Conclusion: The association between FSHR rs6166 and POR was not statistically meaningful in the present study, but the near-significant result of this experiment suggests that statistical significance might be found in a future study with a larger number of patients.

scholarly journals Cognitive Functions in Repeated Glioma Surgery

Cancers ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1077
Author(s):  
Gabriele Capo ◽  
Miran Skrap ◽  
Ilaria Guarracino ◽  
Miriam Isola ◽  
Claudio Battistella ◽  
...  
Keyword(s):  
Cognitive Functions ◽  
Inferior Frontal Gyrus ◽  
Insular Cortex ◽  
Malignant Degeneration ◽  
Low Grade ◽  
Normal Range ◽  
Glioma Surgery ◽  
Number Of Patients ◽  
Significant Difference

Low-grade gliomas (LGG) are slow-growing brain tumors infiltrating the central nervous system which tend to recur, often with malignant degeneration after primary treatment. Re-operations are not always recommended due to an assumed higher risk of neurological and cognitive deficits. However, this assumption is relatively ungrounded due to a lack of extensive neuropsychological testing. We retrospectively examined a series of 40 patients with recurrent glioma in eloquent areas of the left hemisphere, who all completed comprehensive pre- (T3) and post-surgical (T4) neuropsychological assessments after a second surgery (4-month follow up). The lesions were most frequent in the left insular cortex and the inferior frontal gyrus. Among this series, in 17 patients the cognitive outcomes were compared before the first surgery (T1), 4 months after the first surgery (T2), and at T3 and T4. There was no significant difference either in the number of patients scoring within the normal range between T3 and T4, or in their level of performance. Further addressing the T1–T4 evolution, there was no significant difference in the number of patients scoring within the normal range. As to their level of performance, the only significant change was in phonological fluency. This longitudinal follow-up study showed that repeated glioma surgery is possible without major damage to cognitive functions in the short-term period (4 months) after surgery.

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

2019 ◽  
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.

Transsellar Ultrasound in Pituitary Surgery With a Designated Probe

2015 ◽  
Vol 12 (2) ◽  
pp. 128-134 ◽  
Author(s):  
Ole Solheim ◽  
Tonni Franke Johansen ◽  
Johan Cappelen ◽  
Geirmund Unsgård ◽  
Tormod Selbekk
Keyword(s):  
Transsphenoidal Surgery ◽  
Intraoperative Imaging ◽  
Intraoperative Ultrasound ◽  
Pituitary Surgery ◽  
Extent Of Resection ◽  
Center Frequency ◽  
Ultrasound Probe ◽  
Flexible Form ◽  
Intraoperative Ultrasound Imaging ◽  
Surgical Field

Abstract BACKGROUND Anatomic orientation in transsphenoidal surgery can be difficult, and residual tumors are common. A major limitation of both direct microscopy and endoscopic visualization is the inability to see below the surface of the surgical field to confirm the location of vessels, nerves, tumor remnants, and normal pituitary tissue. OBJECTIVE To present our initial experience with a new forward-looking, custom-designed ultrasound probe for transsellar imaging. METHODS The center frequency of the prototype tightly curved linear array, bayonet-shaped probe is 12 MHz. Twenty-four patients with pituitary adenomas were included after informed consent. RESULTS With the use of transsellar ultrasound, we could confirm the location of important neurovascular structures and improve the extent of resection in 4 of 24 cases, as rated subjectively by the operating surgeons. Image quality was good. In 17 patients (71%), biochemical cures and/or complete resections were confirmed at 3 months. CONCLUSION We found the images from our custom-designed ultrasound probe to be clinically helpful for anatomic orientation during surgery, and the technology is potentially helpful for improving the extent of resection during transsphenoidal surgery. This quick and flexible form of intraoperative imaging in transsphenoidal surgery could be of great support for surgeons in both routine use and difficult cases. The concept of transsellar intraoperative ultrasound imaging can be further refined and developed.

scholarly journals Functional preoperative and intraoperative mapping and monitoring: increasing safety and efficacy in glioma surgery

2015 ◽  
Vol 38 (1) ◽  
pp. E3 ◽  
Author(s):  
Malte Ottenhausen ◽  
Sandro M. Krieg ◽  
Bernhard Meyer ◽  
Florian Ringel
Keyword(s):  
Diffusion Tensor ◽  
Imaging Techniques ◽  
Extent Of Resection ◽  
Low Grade ◽  
Glioma Surgery ◽  
Intraoperative Mapping ◽  
Fiber Tracts ◽  
Functional Localization ◽  
Eloquent Cortex ◽  
Cortical Regions

Greater extent of resection (EOR) of low-grade gliomas is associated with improved survival. Proximity to eloquent cortical regions often limits resectability and elevates the risk of surgery-related deficits. Therefore, functional localization of eloquent cortex or subcortical fiber tracts can enhance the EOR and functional outcome. Imaging techniques such as functional MRI and diffusion tensor imaging fiber tracking, and neurophysiological methods like navigated transcranial magnetic stimulation and magnetoencephalography, make it possible to identify eloquent areas prior to resective surgery and to tailor indication and surgical approach but also to assess the surgical risk. Intraoperative monitoring with direct cortical stimulation and subcortical stimulation enables surgeons to preserve essential functional tissue during surgery. Through tailored pre- and intraoperative mapping and monitoring the EOR can be maximized, with reduced rates of surgery-related deficits.

Incidental Low-Grade Gliomas: Single-Institution Management Based on Clinical, Surgical, and Molecular Data

Neurosurgery ◽  
2019 ◽  
Author(s):  
Tamara Ius ◽  
Daniela Cesselli ◽  
Miriam Isola ◽  
Giada Pauletto ◽  
Barbara Tomasino ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Dna Methyltransferase ◽  
Tumor Volume ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Molecular Profile ◽  
Karnofsky Performance Scale ◽  
Low Grade ◽  
Extensive Resection ◽  
Low Grade Gliomas

Abstract BACKGROUND Incidentally discovered diffuse low-grade gliomas (iLGG) are poorly documented in the literature. They are diagnosed by chance during radiological examinations. OBJECTIVE To review a cohort of patients with iLGG surgically treated in our institution, analyzing clinical, molecular, and surgical aspects. METHODS Clinical, radiological, and treatment data of iLGG were retrieved and compared with those of symptomatic diffuse LGGs (sLGG). Histological and molecular review was carried out as well. The extent of resection was evaluated on preoperative and postoperative T2-weighted magnetic resonance imaging. RESULTS Thirty-four iLGG cases were identified within a monoinstitutional cohort of 332 patients operated for low-grade gliomas from 2000 to 2017. Clinically, patients with iLGG had higher preoperative karnofsky performance scale (KPS) (P = .003), smaller tumor volume (P = .0001), lower frequency of eloquent areas involvement (P = .0001), and higher rate of complete resection (P = .0001) compared to those with sLGG. No differences in the molecular profile and O6-methylguanine-DNA-methyltransferase promoter methylation were detected between iLGG and sLGG. Importantly, patients with iLGG had longer overall survival than those with sLGG (P = .0001), even when a complete surgical resection was achieved (P = .001). CONCLUSION Although the therapeutic strategy of iLGG is still a matter of debate, our data support the safety and the effectiveness of early surgical resection. The favorable prognosis of iLGG may be due to the higher practicability of extensive resection, noneloquent tumor location, and smaller tumor volume.

Intraoperative ultrasound in low-grade glioma surgery

2015 ◽  
Vol 135 ◽  
pp. 96-99 ◽  
Author(s):  
Andrej Šteňo ◽  
Viktor Matejčík ◽  
Juraj Šteňo
Keyword(s):  
Intraoperative Ultrasound ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Glioma Surgery

scholarly journals Ultrasonographic Assessment of Metoclopramide Administration Effectiveness in Accelerating Gastric Emptying Before Urgent Surgery in Patients with Insufficient NPO Time

2020 ◽  
Vol 10 (5) ◽  
Author(s):  
Shahram Sayyadi ◽  
Masoomeh Raoufi ◽  
Ali Arhami Dolatabadi ◽  
Marzieh Rostami ◽  
Elham Memary
Keyword(s):  
Gastric Emptying ◽  
General Anesthesia ◽  
Intervention Group ◽  
Test Method ◽  
Control Group ◽  
P Value ◽  
High Morbidity ◽  
Expert Radiologist ◽  
Number Of Patients ◽  
The Mean

Background: Aspiration is one of the important complications of general anesthesia, although infrequent as well as accompanying high morbidity and mortality. The volume of gastric content is considered as a risk factor in this regard. Therefore, it is normally mostly recommend to consider proper fasting time before induction of general anesthesia. Objectives: This study was conducted to assess the effect of metoclopramide on reducing gastric contents in patients with incomplete fasting before induction of general anesthesia. Methods: This quasi-experimental study was conducted on patients with urgent surgical indications with incomplete NPO time. Every other patient received metoclopramide or placebo. Patients in the intervention group received 10 mg (2 ml) of intravenous metoclopramide, and patients in the control group received 2 ml of distilled water as a placebo. Patients in both groups underwent ultrasonography before starting surgery by an expert radiologist to calculate gastric antral grade (GAG) and cross-sectional antral area (CSA). These measurements were then taken for the second time 30 minutes after intervention, before starting the surgery. The values were compared statistically. Results: The data of 60 patients were analyzed, of which 30 were in each group. The mean age, body mass index, type of the last consumed food (solid or fluid), NPO time in the two groups were not significantly different (P value > 0.05). The number of patients in the metoclopramide group with higher GAG (P value = 0.001) and the mean CSA (P value = 0.004) before the intervention was more than the control group. The GAG and mean CSA after intervention were not significantly different between the two groups; but the mean difference of decrease in CSA in the metoclopramide group was more than the control group (4.3 vs. 0.99; P value = 0.001), and changes of GAG after intervention to lower levels in the metoclopramide group was more than the control group (P value < 0.05). Conclusions: In the current study in which ultrasonographic indexes, including GAG and CSA, were assessed as a suboptimal gastric emptying test method, it was found that metoclopramide could accelerate gastric emptying compared to placebo in patients with incomplete fasting before induction of general anesthesia.

scholarly journals Evaluation of Post-Operative Analgesia Using Clonidine as an Adjuvant with Caudal Bupivacaine in Paediatric Patients Posted for Infraumbilical Surgery

2021 ◽  
Vol 10 (35) ◽  
pp. 3005-3011
Author(s):  
Sinjini Agarwal ◽  
Neeta Chaudhari Verma ◽  
Amol P.S. ◽  
Pyarelal Pyarelal ◽  
Suzanna Elsa Varghese ◽  
...  
Keyword(s):  
Normal Saline ◽  
Ethical Review ◽  
Control Group ◽  
P Value ◽  
Paediatric Surgery ◽  
Rescue Analgesia ◽  
Significant Group ◽  
Number Of Patients ◽  
Group B ◽  
Caudal Epidural

BACKGROUND Caudal epidural block is a highly popular method of administering analgesia to children undergoing infraumbilical surgeries. Addition of clonidine, a centrally acting alpha 2 agonist as an adjuvant to caudal bupivacaine has added advantages of providing prolonged post-operative analgesia and also, thus reducing the number of doses of post-operative rescue analgesics. In this study, we wanted to compare the efficacy and safety of caudally administered clonidine as an adjuvant to bupivacaine. METHODS This was a prospective, comparative interventional study and was conducted in the Department of Anaesthesia at JNMC, Sawangi (Meghe) Wardha in accordance with the guidelines and permission of the institutional ethical review board. The study was carried out with 40 patients in each group randomly allocated using computer generated software, posted for infraumbilical surgeries between the age group 2 years to 7 years, American Society of Anaesthesiologists (ASA) grade I and II. Group B (control group) – Caudal epidural with 0.25 % bupivacaine 1 ml/kg + 1 ml normal saline. Group C (study group)- Caudal epidural with 0.25 % bupivacaine 1 ml/kg with clonidine 1 microgram/kg + 1 ml normal saline. RESULTS In our study, the mean duration of analgesia i.e. mean time for requirement of first rescue analgesia in group C was 9.9 ± 1.4 hours as compared to 4.7 ± 1.4 hours in group B (P < 0.0001). In this study, we used FLACC (face, legs, activity, cry, consolability) pain scale with its 0 - 10 score range for assessing the pain intensity. At FLACC pain score 4 or more, first dose of rescue analgesic was given. This score was reached at 8.8 hours in Group C (mean FLACC score at 3.8 ± 0.7) and 3.6 hours in Group B (mean FLACC score 3.4 ± 0.9) with P value (= 0.014) (significant). Group C required significantly lesser number of rescue analgesics in comparison to Group B. The number of doses of rescue analgesics required in the Group B were definitely more than that in Group C wherein 62.5 % required 3 doses and 25 % required 4 doses of rescue analgesics. On the other hand, in Group C the number of patients requiring more than 2 doses of rescue analgesia was 0 % thus proving the efficacy of clonidine in prolonging post-operative analgesia. CONCLUSIONS We concluded that caudally administered clonidine, in a dose of 1 microgram/kg as an adjuvant to 0.25 % bupivacaine 1 ml/kg, proved to be efficacious in providing prolonged analgesia both intraoperatively and post-operatively. Also, we observed that this addition, reduced the requirement of post-operative rescue analgesia and its associated side effects. KEY WORDS Caudal Epidural, Infraumbilical Paediatric Surgery, Clonidine, Bupivacaine, Postoperative Analgesia

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