Background: Adult thalamic gliomas (ATGs) present a surgical challenge given their depth and proximity to eloquent brain regions.Though a relative abundance of literature has been published regarding the surgical management of thalamic lesions in pediatric patients, a scarce amount exists dedicated to adult populations. Methods: Literature regarding surgical management of thalamic gliomas in adult patients was reviewed according to the PRISMA guidelines. Fours databases were searched with keywords “‘thalamic glioma’ AND ‘surgical intervention’ OR ‘thalamic glioma’ AND ‘surgical treatment’” in July 2021 for articles assessing surgical techniques of ATG resection. Results: The mean age of adult undergoing surgical management was 33.57 years with a median preoperative KPS of 72.15. Among the 507 cases, several surgical approaches were utilized. Transcortical approaches were most frequently used accounting for 37.8% of all cases followed by transventricular (23.8%), transcallosal (22.8%), and trans-sylvian transinsular (2.92%). Conclusions: Studies in this review agree that decreased age, low grade glioma, increased KPS, and increased duration of symptoms are positive prognostic factors. Greater degree of resection provides a positive survival benefit, and transcortical approaches appear to carry a greater overall survival. Stratified guidelines could pose an overall advantage to surgical success when making decisions on treatment approach.
implementing a quality improvement protocol in January 2022 in which pulse rate and frame rate were reduced from 15 p/s to 7.5 p/s and 7.5 f/s to 4.0 f/s respectively. We studied consecutive, unilateral middle meningeal artery embolizations treated with particles. Total radiation dose, radiation per angiographic run, total radiation exposure, and exposure per run were calculated. Multivariable log-linear regression was performed to account for patient body mass index (BMI), number of angiographic runs, and number of vessels catheterized. Statistical analysis was performed using STATA MP Version 17.0 (Stata Corp LP, College Station, Texas). Significance was defined as p < 0.05. Results A total of 16 consecutive, unilateral middle meningeal artery embolizations were retrospectively analyzed, 8 prior to the protocol change and 8 after (table 1). Univariable analysis revealed that radiation dose (660.9 vs. 407.5 mGy, p=0.002), radiation dose per angiographic run (40.3 vs. 25.7, p<0.001), total radiation exposure (8825.8 vs. 5510.4 mGym 2 , p=0.002), and exposure per run (537.9 vs. 353.5, p=0.002) were all significantly decreased after the protocol was implemented. Average patient BMI, fluoroscopy time, number of vessels catheterized, and number of angiographic runs did not differ between groups, demonstrating consistency in practice despite the change in protocol.On multivariable log-linear regression adjusting for BMI, number of runs, vessels catheterized, and fluoroscopy time, the radiation reduction protocol was associated with a 33.8% decrease in the total radiation dose (95% Confidence Interval [CI] 8.0-59.6%, p=0.015) and a 34.8% decrease in radiation dose per run (11.7-57.8%, p=0.007). The protocol was associated with a 32.8% decrease in the total radiation exposure (6.5-59.1%), p=0.019) and a 33.8% decrease in exposure per run (10.0-57.6, p=0.010). Conclusion Radiation reduction protocols can be readily applied to neuroendovascular interventions without increasing overall fluoroscopy time and reduce radiation dose and exposure by 32.8% and 33.8% respectively. We strongly encourage all interventionalists to be cognizant of pulse rate and frame rate when performing routine interventions to avoid unnecessary radiation towards patients, providers, and health care staff.
different microcatheters such as the Prowler EX and Select Plus (Cerenovus), Phenom 21 and 27 (Medtronic), Via 17 and 33 (Microvention), Trevo Pro 18 and Excelsior SL-10 (Stryker), over a Glidewire 0.035-inch in one case and over the Tenzing 7 insert catheter (Route 92) in 2 cases. The most distal vessel in which the tip of the Esperance catheter was placed was the petrous ICA (n=1), cavernous ICA (n=5), ICA terminus/communicating segment (n=2), M2/MCA (n=1), V3 segment (n=2), basilar artery (n=2), Internal maxillary artery (n=1) and transverse sinus (n=1). The catheter offered the desired support in all cases. The catheter was never exchanged due to lack of support and/or inability to perform the procedure. No catheter related complications occurred. Conclusion The Esperance catheter is a new device in the neurointerventional toolbox. It can be safely and successfully used for a variety of procedures. Disclosures A.
Background: 5-aminolevulinic acid (5-ALA) enhances intraoperative high grade glioma (HGG) tissue visualization. Despite promising randomized clinical trial data suggesting survival benefit for 5-ALA-guided HGG surgery, patient outcome efficacy is not universally accepted. Methods: We performed a systematic review of the literature to evaluate whether there is a beneficial effect upon survival and extent of resection from the utilization of 5-ALA in HGG surgery. Literature regarding 5-ALA usage in HGG surgery was reviewed according to PRISMA guidelines. Results: 3,756 published studies were screened, 536 evaluated, and 45 included. Of studies that directly compared the use of 5-ALA to white light (28.9%), 5-ALA lead to a better progression-free survival (PFS) and overall survival (OS) in 88.4 and 67.5% of patients, respectively. 42.2% demonstrated that 5-ALA use was associated with less post-op neurological deficits, whereas 23.3% of studies showed that surgeries using 5-ALA lead to more deficits. 34.5% demonstrated no difference between 5-ALA and without. Conclusions: 5-ALA was found to be associated with a greater extent of resection and longer OS and PFS in HGG surgeries. Postop neurologic deficit rates were inconclusive when comparing 5-ALA groups to white light groups. 5-ALA is a useful surgical adjunct for HGG resection with preserved patient safety.
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