scholarly journals Surgical management of incidentally discovered low-grade gliomas

2020 ◽  
pp. 1-8
Author(s):  
Andrew J. Gogos ◽  
Jacob S. Young ◽  
Matheus P. Pereira ◽  
Ramin A. Morshed ◽  
Matthew B. Potts ◽  
...  
Keyword(s):  
Overall Survival ◽  
San Francisco ◽  
Mass Effect ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Observation Time ◽  
Neurological Deficits ◽  
Low Grade ◽  
Imaging Data ◽  
Incidental Lesions

OBJECTIVEAlthough most patients with low-grade glioma (LGG) present after a seizure, a small proportion is diagnosed after neuroimaging is performed for a sign or symptom unrelated to the tumor. While these tumors invariably grow, some surgeons argue for a watchful waiting approach. Here, the authors report on their experience in the surgical treatment of patients with incidental LGG (iLGG) and describe the neurological outcomes, survival, and complications.METHODSRelevant cases were identified from a prospective registry of patients undergoing glioma resection at the University of California, San Francisco, between 1997 and 2019. Cases were considered iLGG when the lesion was noted on imaging performed for a reason unrelated to the tumor. Demographic, clinical, pathological, and imaging data were extracted from the electronic medical record. Tumor volumes, growth, and extent of resection were calculated from pre- and postoperative volumetric FLAIR sequences.RESULTSOne hundred thirteen of 657 (17.2%) first-time resections for LGG were for incidental lesions. The most common reasons for the discovery of an iLGG were headaches (without mass effect, 34.5%) or trauma (16.8%). Incidental tumors were no different from symptomatic lesions in terms of laterality or location, but they were significantly smaller (22.5 vs 57.5 cm3, p < 0.0001). There was no difference in diagnosis between patients with iLGG and those with symptomatic LGG (sLGG), incorporating both molecular and pathological data. The median preoperative observation time for iLGG was 3.1 months (range 1 month–12 years), and there was a median growth rate of 3.9 cm3/year. Complete resection of the FLAIR abnormality was achieved in 57% of patients with incidental lesions but only 23.8% of symptomatic lesions (p < 0.001), and the residual volumes were smaller for iLGGs (2.9 vs 13.5 cm3, p < 0.0001). Overall survival was significantly longer for patients with incidental tumors (median survival not reached for patients with iLGG vs 14.6 years for those with sLGG, p < 0.0001). There was a 4.4% rate of neurological deficits at 6 months.CONCLUSIONSThe authors present the largest cohort of iLGGs. Patient age, tumor location, and molecular genetics were not different between iLGGs and sLGGs. Incidental tumors were smaller, a greater extent of resection could be achieved, and overall survival was improved compared to those for patients with sLGG. Operative morbidity and rates of neurological deficit were acceptably low; thus, the authors advocate upfront surgical intervention aimed at maximal safe resection for these incidentally discovered lesions.

scholarly journals Profound hearing loss following surgery in pediatric patients with posterior fossa low-grade glioma

2017 ◽  
Vol 5 (2) ◽  
pp. 96-103 ◽  
Author(s):  
Yahya Ghazwani ◽  
Ibrahim Qaddoumi ◽  
Johnnie K Bass ◽  
Shengjie Wu ◽  
Jason Chiang ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Posterior Fossa ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Low Grade Glioma ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Low Grade ◽  
Total Resection ◽  
Profound Hearing Loss

Abstract Background Hearing loss may occur in patients with posterior fossa low-grade glioma who undergo surgery. Methods We retrospectively reviewed 217 patients with posterior fossa low-grade glioma, including 115 for whom results of hearing tests performed after surgery and before chemotherapy or radiation therapy were available. We explored the association of UHL with age at diagnosis, sex, race, tumor location, extent of resection, posterior fossa syndrome, ventriculoperitoneal shunt placement, and histology. Results Of the 115 patients, 15 (13.0%: 11 male, 6 black, 8 white, 1 multiracial; median age 7 years [range, 1.3–17.2 years]) had profound UHL after surgery alone or before receiving ototoxic therapy. Median age at tumor diagnosis was 6.8 years (range, 0.7–14.1 years), and median age at surgery was 6.8 years (range, 0.7–14.1 years). Patients with UHL had pathology characteristic of pilocytic astrocytoma (n = 10), ganglioglioma (n = 4), or low-grade astrocytoma (n = 1). Of these 15 patients, 4 underwent biopsy, 1 underwent gross total resection, 1 underwent near-total resection, and 9 underwent subtotal resection. UHL was more frequent in black patients than in white patients (OR 7.3, P = .007) and less frequent in patients who underwent gross total resection or near-total resection than in those who underwent subtotal resection (OR 0.11, P = .02). Conclusions Children undergoing surgery for posterior fossa low-grade glioma are at risk for UHL, which may be related to race or extent of resection. These patients should receive postoperative audiologic testing, as earlier intervention may improve outcomes.

Surgery for low-grade glioma infiltrating the central cerebral region: location as a predictive factor for neurological deficit, epileptological outcome, and quality of life

2013 ◽  
Vol 119 (2) ◽  
pp. 318-323 ◽  
Author(s):  
Philippe Schucht ◽  
Fadi Ghareeb ◽  
Hugues Duffau
Keyword(s):  
Quality Of Life ◽  
Return To Work ◽  
Seizure Control ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Neurological Deficits ◽  
Main Concern ◽  
Low Grade ◽  
Who Grade

Object A main concern with regard to surgery for low-grade glioma (LGG, WHO Grade II) is maintenance of the patient's functional integrity. This concern is particularly relevant for gliomas in the central region, where damage can have grave repercussions. The authors evaluated postsurgical outcomes with regard to neurological deficits, seizures, and quality of life. Methods Outcomes were compared for 33 patients with central LGG (central cohort) and a control cohort of 31 patients with frontal LGG (frontal cohort), all of whom had had medically intractable seizures before undergoing surgery with mapping while awake. All surgeries were performed in the period from February 2007 through April 2010 at the same institution. Results For the central cohort, the median extent of resection was 92% (range 80%–97%), and for the frontal cohort, the median extent of resection was 93% (range 83%–98%; p = 1.0). Although the rate of mild neurological deficits was similar for both groups, seizure freedom (Engel Class I) was achieved for only 4 (12.1%) of 33 patients in the central cohort compared with 26 (83.9%) of 31 patients in the frontal cohort (p < 0.0001). The rate of return to work was lower for patients in the central cohort (4 [12.1%] of 33) than for the patients in the frontal cohort (28 [90.3%] of 31; p < 0.0001). Conclusions Resection of central LGG is feasible and safe when appropriate intraoperative mapping is used. However, seizure control for these patients remains poor, a finding that contrasts markedly with seizure control for patients in the frontal cohort and with that reported in the literature. For patients with central LGG, poor seizure control ultimately determines quality of life because most will not be able to return to work.

scholarly journals Prognostic significance of clinical parameters in patients with cerebral low-grade glioma

2020 ◽  
pp. 85-85
Author(s):  
Milos Jokovic ◽  
Radovan Mijalcic ◽  
Vladimir Bascarevic ◽  
Nemanja Jovanovic
Keyword(s):  
Overall Survival ◽  
Tumor Biology ◽  
Prognostic Significance ◽  
Extent Of Resection ◽  
Categorical Variables ◽  
Low Grade ◽  
Clinical Parameters ◽  
Site Location ◽  
Who Grade ◽  
Low Grade Gliomas

Introduction/Objective. Low-grade gliomas (LGG) affect younger adults and carry a favorable prognosis. We aim to describe clinical patterns of low-grade gliomas as well as prognosis in different groups of patients. Our intention was to determine clinical parameters that may affect prognosis, and whether a greater extent of resection would increase the long-term progression-free or overall survival of patients with low-grade gliomas. Methods. We analyzed data obtained from the files of the patients with a diagnosis of WHO grade II gliomas. The relationships among categorical variables were analyzed using standard statistical tools and a 95% confidence interval (CI). Results. We analyzed 118 patients with median age of 34 years. Over 57% were male and the primary site location was the cerebrum. All these patients were operated on and some of them received radiation and/or chemotherapy. Median overall survival was 9.6 years and better prognosis is associated with younger age, frontal and noneloquent zone location, seizures as the first symptom of disease and gross total resection of the tumor. Indications for early surgery are increased intracranial pressure, preoperative neurologic deficit, tumor size larger than 6 cm with contrast enhancement and older age. Conclusion. Tumor location, 1p/19q co-deletion and age were the main determinants of treatment received and overall survival, likely reflecting tumor biology differences. Any form of treatment was preferred over watchful waiting. This study found that a greater extent of resection could significantly increase the overall survival of patients with low-grade gliomas.

Circumferential sulcus-guided resection technique for improved outcomes of low-grade gliomas

2022 ◽  
pp. 1-11
Keyword(s):  
Extent Of Resection ◽  
Neurological Complications ◽  
Low Grade ◽  
Newly Diagnosed ◽  
Imaging Data ◽  
Volumetric Imaging ◽  
Exact Test ◽  
Low Grade Gliomas ◽  
Presenting Symptoms ◽  
Piecemeal Resection

OBJECTIVE Many neurosurgeons resect nonenhancing low-grade gliomas (LGGs) by using an inside-out piecemeal resection (PMR) technique. At the authors’ institution they have increasingly used a circumferential, perilesional, sulcus-guided resection (SGR) technique. This technique has not been well described and there are limited data on its effectiveness. The authors describe the SGR technique and assess the extent to which SGR correlates with extent of resection and neurological outcome. METHODS The authors identified all patients with newly diagnosed LGGs who underwent resection at their institution over a 22-year period. Demographics, presenting symptoms, intraoperative data, method of resection (SGR or PMR), volumetric imaging data, and postoperative outcomes were obtained. Univariate analyses used ANOVA and Fisher’s exact test. Multivariate analyses were performed using multivariate logistic regression. RESULTS Newly diagnosed LGGs were resected in 519 patients, 208 (40%) using an SGR technique and 311 (60%) using a PMR technique. The median extent of resection in the SGR group was 84%, compared with 77% in the PMR group (p = 0.019). In multivariate analysis, SGR was independently associated with a higher rate of complete (100%) resection (27% vs 18%) (OR 1.7, 95% CI 1.1–2.6; p = 0.03). SGR was also associated with a statistical trend toward lower rates of postoperative neurological complications (11% vs 16%, p = 0.09). A subset analysis of tumors located specifically in eloquent brain demonstrated SGR to be as safe as PMR. CONCLUSIONS The authors describe the SGR technique used to resect LGGs and show that SGR is independently associated with statistically significantly higher rates of complete resection, without an increase in neurological complications, than with PMR. SGR technique should be considered when resecting LGGs.

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.

The benefit of early surgery on overall survival in incidental low-grade glioma patients: A multicenter study

2021 ◽  
Author(s):  
Tamara Ius ◽  
Sam Ng ◽  
Jacob S Young ◽  
Barbara Tomasino ◽  
Maurizio Polano ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multicenter Study ◽  
Tumor Volume ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
Early Surgery ◽  
Low Grade ◽  
Surgical Data ◽  
Supratotal Resection

Abstract Background The role of surgery for incidentally discovered diffuse incidental low-grade gliomas (iLGGs) is debatable and poorly documented in current literature. Objective The aim was to identify factors that influence survival for patients that underwent surgical resection of iLGGs in a large multicenter population. Methods Clinical, radiological, and surgical data were retrospectively analyzed in 267 patients operated for iLGG from 4 neurosurgical Centers. Univariate and multivariate analyses were performed to identify predictors of overall survival (OS) and tumor recurrence (TR). Results The OS rate was 92.41%. The 5- and 10-year estimated OS rates were 98.09% and 93.2%, respectively. OS was significantly longer for patients with a lower preoperative tumor volume (P = .001) and higher extent of resection (EOR) (P = .037), regardless the WHO-defined molecular class (P = .2). In the final model, OS was influenced only by the preoperative tumor volume (P = .006), while TR by early surgery (P = .028). A negative association was found between preoperative tumor volumes and EOR (rs = −0.44, P &lt; .001). The median preoperative tumor volume was 15 cm3. The median EOR was 95%. Total or supratotal resection of T2-FLAIR abnormality was achieved in 61.62% of cases. Second surgery was performed in 26.22%. The median time between surgeries was 5.5 years. Histological evolution to high-grade glioma was detected in 22.85% of cases (16/70). Permanent mild deficits were observed in 3.08% of cases. Conclusions This multicenter study confirms the results of previous studies investigating surgical management of iLGGs and thereby strengthens the evidence in favor of early surgery for these lesions.

Intraoperative 3D ultrasound–guided resection of diffuse low-grade gliomas: radiological and clinical results

2020 ◽  
Vol 132 (2) ◽  
pp. 518-529 ◽  
Author(s):  
Hans Kristian Bø ◽  
Ole Solheim ◽  
Kjell-Arne Kvistad ◽  
Erik Magnus Berntsen ◽  
Sverre Helge Torp ◽  
...  
Keyword(s):  
General Anesthesia ◽  
San Francisco ◽  
Prognostic Score ◽  
Three Dimensional ◽  
Residual Tumor ◽  
Clinical Results ◽  
Extent Of Resection ◽  
3D Ultrasound ◽  
Low Grade ◽  
Postoperative Mri

OBJECTIVEExtent of resection (EOR) and residual tumor volume are linked to prognosis in low-grade glioma (LGG) and there are various methods for facilitating safe maximal resection in such patients. In this prospective study the authors assess radiological and clinical results in consecutive patients with LGG treated with 3D ultrasound (US)–guided resection under general anesthesia.METHODSConsecutive LGGs undergoing primary surgery guided with 3D US between 2008 and 2015 were included. All LGGs were classified according to the WHO 2016 classification system. Pre- and postoperative volumetric assessments were performed, and volumetric results were linked to overall and malignant-free survival. Pre- and postoperative health-related quality of life (HRQoL) was evaluated.RESULTSForty-seven consecutive patients were included. Twenty LGGs (43%) were isocitrate dehydrogenase (IDH)–mutated, 7 (14%) were IDH wild-type, 19 (40%) had both IDH mutation and 1p/19q codeletion, and 1 had IDH mutation and inconclusive 1p/19q status. Median resection grade was 93.4%, with gross-total resection achieved in 14 patients (30%). An additional 24 patients (51%) had small tumor remnants < 10 ml. A more conspicuous tumor border (p = 0.02) and lower University of California San Francisco prognostic score (p = 0.01) were associated with less remnant tumor tissue, and overall survival was significantly better with remnants < 10 ml (p = 0.03). HRQoL was maintained or improved in 86% of patients at 1 month. In both cases with severe permanent deficits, relevant ischemia was present on diffusion-weighted postoperative MRI.CONCLUSIONSThree-dimensional US–guided LGG resections under general anesthesia are safe and HRQoL is preserved in most patients. Effectiveness in terms of EOR appears to be consistent with published studies using other advanced neurosurgical tools. Avoiding intraoperative vascular injury is a key factor for achieving good functional outcome.

Malignant hemangiopericytoma: Treatment patterns and survival.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13520-e13520
Author(s):  
Rolando Barjas ◽  
David Eric Piccioni
Keyword(s):  
Overall Survival ◽  
Cox Model ◽  
Demographic Data ◽  
Extent Of Resection ◽  
Treatment Patterns ◽  
Subtotal Resection ◽  
Low Grade ◽  
Who Grade ◽  
Fibrous Tumor ◽  
Grade Iii

e13520 Background: Hemangiopericytoma (HPC), or solitary fibrous tumor of the central nervous system (CNS), is a rare mesenchymal tumor that arises from the pericytes of the meningeal capillaries. These tumors account for less than 1% of all CNS tumors and are categorized into low-grade (WHO grade I and II) or high-grade (WHO grade III, anaplastic) neoplasms. The optimal treatment for grade III HPC is unclear. The aim of this study was to evaluate treatment patterns and survival for grade III HPC using the California Cancer Registry (CCR). Methods: Treatment and demographic data were extracted from the CCR for patients with grade III HPC of the CNS, from 1988-2010. Overall Survival (OS) was evaluated as a function of treatment (surgery, radiation or both), as well as extent of resection. Kaplan Meier survival analyses were performed for OS. Bivariate and multivariable analyses were done via cox proportional hazard regression models for all demographic and treatment variables. Results: A total of 94 patients with grade III HPC were identified from the registry. The most prevalent demographics were age > 50 years (59%), female (61%), non-Hispanic White (60%), and married (54%). 54% received radiation, and subtotal resection (STR) (63%) was the most common surgical outcome. However, survival was greatest in patients that received gross total resection (GTR) with radiation (median OS not reached). GTR/radiation (median OS not reached) demonstrated improved OS compared to STR/radiation (median OS 10.3 years; HR = 0.389, 95%CI 0.157-0.960) or GTR alone (median OS 6.6 years; HR = 0.254, 95%CI 0.073-0.880). Age < 50 (median OS 15.7 years), Asian/PI (median OS not reached) and married (median OS 9.9 years) were significant predictors of OS. In the multivariable cox model worse overall survival remained for older age (HR = 3.079, 95%CI 1.428-6.636) and divorced/widowed/separated (HR = 2.027, 95%CI 1.054-3.897) when compared to their younger and married counterparts. Conclusions: Patients that received GTR and radiation demonstrated the best long-term prognosis. Demographic analyses identified additional independent predictors of survival.

Impact of extent of resection for recurrent glioblastoma on overall survival

2012 ◽  
Vol 117 (6) ◽  
pp. 1032-1038 ◽  
Author(s):  
Orin Bloch ◽  
Seunggu J. Han ◽  
Soonmee Cha ◽  
Matthew Z. Sun ◽  
Manish K. Aghi ◽  
...  
Keyword(s):  
Overall Survival ◽  
San Francisco ◽  
Median Survival ◽  
Karnofsky Performance Status ◽  
Extent Of Resection ◽  
Cox Proportional Hazards Model ◽  
Subtotal Resection ◽  
Repeat Resection ◽  
The Impact ◽  
Initial Resection

Object Extent of resection (EOR) has been shown to be an important prognostic factor for survival in patients undergoing initial resection of glioblastoma (GBM), but the significance of EOR at repeat craniotomy for recurrence remains unclear. In this study the authors investigate the impact of EOR at initial and repeat resection of GBM on overall survival. Methods Medical records were reviewed for all patients undergoing craniotomy for GBM at the University of California San Francisco Medical Center from January 1, 2005, through August 15, 2009. Patients who had a second craniotomy for pathologically confirmed recurrence following radiation and chemotherapy were evaluated. Volumetric EOR was measured and classified as gross-total resection (GTR, > 95% by volume) or subtotal resection (STR, ≤ 95% by volume) after independent radiological review. Overall survival was compared between groups using univariate and multivariate analysis accounting for known prognostic factors, including age, eloquent location, Karnofsky Performance Status (KPS), and adjuvant therapies. Results Multiple resections were performed in 107 patients. Fifty-two patients had initial GTR, of whom 31 (60%) had GTR at recurrence, with a median survival of 20.4 months (standard error [SE] 1.0 months), and 21 (40%) had STR at recurrence, with a median survival of 18.4 months (SE 0.5 months) (difference not statistically significant). Initial STR was performed in 55 patients, of whom 26 (47%) had GTR at recurrence, with a median survival of 19.0 months (SE 1.2 months), and 29 (53%) had STR, with a median survival of 15.9 months (SE 1.2 months) (p = 0.004). A Cox proportional hazards model was constructed demonstrating that age (HR 1.03, p = 0.004), KPS score at recurrence (HR 2.4, p = 0.02), and EOR at repeat resection (HR 0.62, p = 0.02) were independent predictors of survival. Extent of initial resection was not a statistically significant factor (p = 0.13) when repeat EOR was included in the model, suggesting that GTR at second craniotomy could overcome the effect of an initial STR. Conclusions Extent of resection at recurrence is an important predictor of overall survival. If GTR is achieved at recurrence, overall survival is maximized regardless of initial EOR, suggesting that patients with initial STR may benefit from surgery with a GTR at recurrence.

An extent of resection threshold for newly diagnosed glioblastomas

2011 ◽  
Vol 115 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Nader Sanai ◽  
Mei-Yin Polley ◽  
Michael W. McDermott ◽  
Andrew T. Parsa ◽  
Mitchel S. Berger
Keyword(s):  
Overall Survival ◽  
San Francisco ◽  
Proportional Hazards ◽  
Recursive Partitioning ◽  
Extent Of Resection ◽  
Tumor Burden ◽  
Cox Proportional Hazards ◽  
Survival Advantage ◽  
Karnofsky Performance Scale ◽  
Newly Diagnosed

Object The value of extent of resection (EOR) in improving survival in patients with glioblastoma multiforme (GBM) remains controversial. Specifically, it is unclear what proportion of contrast-enhancing tumor must be resected for a survival advantage and how much survival improves beyond this threshold. The authors attempt to define these values for the patient with newly diagnosed GBM in the modern neurosurgical era. Methods The authors identified 500 consecutive newly diagnosed patients with supratentorial GBM treated at the University of California, San Francisco between 1997 and 2009. Clinical, radiographic, and outcome parameters were measured for each case, including MR imaging–based volumetric tumor analysis. Results The patients had a median age of 60 years and presented with a median Karnofsky Performance Scale (KPS) score of 80. The mean clinical follow-up period was 15.3 months, and no patient was unaccounted for. All patients underwent resection followed by chemotherapy and radiation therapy. The median postoperative tumor volume was 2.3 cm3, equating to a 96% EOR. The median overall survival was 12.2 months. Using Cox proportional hazards analysis, age, KPS score, and EOR were predictive of survival (p < 0.0001). A significant survival advantage was seen with as little as 78% EOR, and stepwise improvement in survival was evident even in the 95%–100% EOR range. A recursive partitioning analysis validated these findings and provided additional risk stratification parameters related to age, EOR, and tumor burden. Conclusions For patients with newly diagnosed GBMs, aggressive EOR equates to improvement in overall survival, even at the highest levels of resection. Interestingly, subtotal resections as low as 78% also correspond to a survival benefit.

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