Low-grade astrocytoma: surgical outcomes in eloquent versus non-eloquent brain areas

Bianco, André de Macedo; Miura, Flávio Key; Clara, Carlos Afonso; Almeida, J. R. W.; Silva, Clemar Corrêa da; Teixeira, Manoel Jacobsen; Marie, Suely Kazue Nagahashi

doi:10.1590/s0004-282x2012005000017

Cited by 13 publications

(11 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The expression of HIF-1α in neoplastic cells was noted in ANBT/peritumoral areas (28/30, 93.3%) adjacent to astrocytomas (12/14 AII, 6/6 AA, and 12/12 GBM). There was statistically insignificant (P = 0.1) gradual increase of mean of percentage of HIF-1α positive neoplastic cells that infiltrate ANBT/peritumoral areas with increasing grade of the studied astrocytomas from AII to AA to GBM (6.4±1.0, 6.7±1.1 and 13±2.9, respectively) as shown in table (2) and Fig (3).…”

Section: Hif1-α Expression In the Studied Anbt /Peritumoral Areas Adjmentioning

confidence: 78%

“…According to WHO classification, diffuse astrocytomas are classified into three grades: diffuse astrocytoma (AII, WHO grade II), anaplastic astrocytoma (AA,WHO grade III) and glioblastoma multiforme (GBM, WHO grade IV) [1]. Despite the indolent histological presentation of AII, they recur at high frequency after conventional treatment and cause death in majority of cases as 50-75% of patients with AII die either from tumor recurrence or malignant progression [2]. The overall survival times show significant variation between cases with a median of 6 years.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of Nestin and Hypoxia Inducible Factor -1α Expression in Apparently Normal Brain Tissue / Peritumoral Areas Adjacent to Astrocytomas

Elsers¹

2014

SECI Onc

View full text Add to dashboard Cite

The surgical biopsy from astrocytomas is usually obtained from enhanced lesion but sometimes may include fragments of apparently normal brain tissue /peritumoral areas. We hypothesize that the evaluation of these fragments for presence of cancer stem cells may have prognostic and /or diagnostic implication. This work has been planned to 1) verify nestin and hypoxia inducible factor-1α location in apparently normal brain tissue/peritumoral areas and its relation to the presence of neoplastic cells in these fragments and 2) analyze the correlation between nestin and hypoxia inducible factor-1 α expression in apparently normal brain tissue/peritumoral areas adjacent to different grades of astrocytomas. Material and Methods: Paraffin-embedded sections of selected thirty specimens of astrocytomas contain apparently normal brain tissue/peritumoral areas (12 diffuse astrocytomas, 6 anaplastic astrocytomas and 12 glioblastoma multiforme) were stained with nestin and hypoxia inducible factor-1α using standard immunohistochemical approaches. The immunoreactivity for nestin and Hypoxia-inducible factor-1 α was evaluated. Results: Compared to nearby astrocytomas, nestin immunoreactivity was scarcely expressed in apparently normal brain tissue/peritumoral tissue. There was statistically significant (P =0.03) gradual increase of mean percentage of nestin positive cells that present in these fragments with increasing grade of the adjacent astrocytomas from diffuse astrocytoma to anaplastic astrocytoma to glioblastoma multiforme (27.1± 4, 38.3±3 and 47.5±5.9, respectively). There was statistically insignificant (P < 0.1) gradual increase of mean percentage of hypoxia inducible factor-1α positive neoplastic cells that infiltrate peritumoral areas with increasing grade of the adjacent astrocytomas. There was statistically significant gradual increase of counting of microvessels that showed positivity for nestin and hypoxia inducible factor-1α expression with increasing grade of the adjacent astrocytomas (P=0.008, P=0.01, respectively). Conclusion: Nestin and hypoxia inducible factor-1α was expressed in apparently normal brain tissue/peritumoral tissue adjacent to astrocytomas. Positivity for nestin in apparently normal fragments may indicate premalignant changes or nearby tumor when a biopsy contain only apparently normal brain tissue. Evaluation of nestin expression in peritumoral areas may have prognostic value as it may be an indicator for rapid recurrence and resistance of treatment.

show abstract

Section: Hif1-α Expression In the Studied Anbt /Peritumoral Areas Adjmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Assessment of Nestin and Hypoxia Inducible Factor -1α Expression in Apparently Normal Brain Tissue / Peritumoral Areas Adjacent to Astrocytomas

Elsers¹

2014

SECI Onc

View full text Add to dashboard Cite

show abstract

“… 2 , 3 , 6 For low grade glioma, though some debate, there is growing evidence that radical excision is associated with improved outcomes. 5 , 8 , 9 , 10 , 11 Current standard treatment of glioblastoma is maximal safe resection, followed by concurrent radiation and chemotherapy (temozolomide) and adjuvant chemotherapy. 14 Despite following this guideline, outcomes have been dismal, and thus, many clinical trials are being attempted.…”

Section: Discussionmentioning

confidence: 99%

“…Even though there is little doubt for low-grade gliomas, but there is growing evidence that radical excision is associated with improved outcomes in the management of low grade glioma and high grade glioma. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 To perform radical resection, many modalities have been used to determine the surgical margin, which is difficult to identify due to the infiltrating features of glioma. Image-guided neurosurgery is a promising modality for maximal resection.…”

Section: Introductionmentioning

confidence: 99%

Clinical Experience of Glioma Surgery Using "Tailed Bullet": Overcoming the Limitations of Conventional Neuro-Navigation Guided Surgery

et al. 2015

View full text Add to dashboard Cite

PurposeAlthough conventional neuro-navigation is a useful tool for image-guided glioma surgery, there are some limitations, such as brain shift. We introduced our methods using an identifiable marker, a "tailed bullet", to overcome the limitation of conventional neuro-navigation. A tailed bullet is an identifiable tumor location marker that determines the extent of a resection and we have introduced our technique and reviewed the clinical results.Materials and MethodsWe have developed and used "tailed bullets" for brain tumor surgery. They were inserted into the brain parenchyma or the tumor itself to help identify the margin of tumor. We retrospectively reviewed surgically resected glioma cases using "tailed bullet". Total 110 gliomas included in this study and it contains WHO grade 2, 3, and 4 glioma was 14, 36, and 60 cases, respectively.ResultsGross total resection (GTR) was achieved in 71 patients (64.5%), subtotal resection in 36 patients (32.7%), and partial resection in 3 patients (2.7%). The overall survival (OS) duration of grade 3 and 4 gliomas were 20.9 (range, 1.2-82.4) and 13.6 months (range, 1.4-173.4), respectively. Extent of resection (GTR), younger age, and higher initial Karnofsky Performance Status (KPS) score were related to longer OS for grade-4 gliomas. There was no significant adverse event directly related to the use of tailed bullets.ConclusionConsidering the limitations of conventional neuro-navigation methods, the tailed bullets could be helpful during glioma resection. We believe this simple method is an easily accessible technique and overcomes the limitation of the brain shift from the conventional neuro-navigation. Further studies are needed to verify the clinical benefits of using tailed bullets.

show abstract

“…Minimal access craniotomies may have several advantages, including reduced length of surgery, lower incidence of wound infections, and shorter length of hospital stay. The minimum size of a craniotomy is, in part, dependent on the size and depth of the lesion as well as on surgical instrumentation [1]. For intra parenchymal lesions at the cortical surface, the craniotomy generally should be large enough to encompass the extent of presentation of the tumor on the surface.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Neuronavigation in Glioma Surgery

Ammar¹,

Mahmoud²,

Kreasha³

et al. 2020

OJMN

View full text Add to dashboard Cite

Background: Glioma is one of the most common intracranial tumors, the treatment for which is surgical resection. Cerebral gliomas in eloquent brain areas are closely associated with important structures. The deep location of such gliomas renders complete resection difficult overlaying structures can be injured, causing hemiplegia, aphasia, coma, and other severe complications. The degree of resection directly influences the prognosis of patients. The application of neuronavigation enables the accurate localization of lesions during surgery, significantly improving microneurosurgery. The accuracy of navigation, however, has typically been compromised by several factors, including operation error, shifting of registration system, and intraoperative brain tissue deformation (brain shift). Aim of Study: The aim of the study is to evaluate and demonstrate the efficacy of neuronavigation in the management of brain gliomas. Patients and Methods: This is a prospective randomized clinical trial study included 35 patients with brain glioma were operated for excision or biopsy taken. Results: Localization of burr hole and craniotomy flap was excellent in 33 patients (94.2%) and fault in 2 cases (5.7%), 29 patients (82.8%) had near total excision of the lesions, and 6 patients (17.1%) had burr hole biopsy, intra operative course was smooth in 33 patients (94.2%) with no intra operative complications, 2 cases (5.7%) developed intra operative bleeding that was due to liver problems. Reading the post operative imaging shows that 27 patients (77.1%) had mild to moderate post operative edema around the site of the lesion, the other eight cases were free of hemorrhage, infarction or edema. Conclusion: We found that neuronavigation is very helpful in our cases in localization of the lesions, decreasing time of surgery, reducing morbidity and mortality and decreasing hospital stay. There are concerns about navigation systems including time consuming, calculation and registration, restriction of space and view inside the operating field, and so on, we didn't find these issues as obstacles in our work, but we found that there are many advantages that can be helpful in the process of operation.

show abstract

Low-grade astrocytoma: surgical outcomes in eloquent versus non-eloquent brain areas

Cited by 13 publications

References 22 publications

Assessment of Nestin and Hypoxia Inducible Factor -1α Expression in Apparently Normal Brain Tissue / Peritumoral Areas Adjacent to Astrocytomas

Assessment of Nestin and Hypoxia Inducible Factor -1α Expression in Apparently Normal Brain Tissue / Peritumoral Areas Adjacent to Astrocytomas

Clinical Experience of Glioma Surgery Using "Tailed Bullet": Overcoming the Limitations of Conventional Neuro-Navigation Guided Surgery

Evaluation of Neuronavigation in Glioma Surgery

Contact Info

Product

Resources

About