Advances in Glioblastoma Operative Techniques

Bander, Evan D; Magge, Rajiv; Ramakrishna, Rohan

doi:10.1016/j.wneu.2018.04.023

Cited by 21 publications

(10 citation statements)

References 87 publications

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“…As a complementary method to pre-operative MRI, fluorescence microscopy has shown its relevance in neuro-oncology [11][12][13][14][15] and 5-aminolevulonic acid (5-ALA) induced fluorescence of protoporphyrin IX (PpIX) is currently used through surgical microscopes [16]. PpIX takes part in the biosynthesis of heme and ingestion of 5-ALA, precursor in heme's biosynthesis, leads to temporary enhancement of PpIX concentration in gliomas [17].…”

mentioning

confidence: 99%

Spectral complexity of 5-ALA induced PpIX fluorescence in guided surgery: a clinical study towards the discrimination of healthy tissue and margin boundaries in high and low grade gliomas

Alston¹,

Mahieu-Williame²,

Hébert³

et al. 2019

Biomed. Opt. Express

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confidence: 99%

Spectral complexity of 5-ALA induced PpIX fluorescence in guided surgery: a clinical study towards the discrimination of healthy tissue and margin boundaries in high and low grade gliomas

Alston¹,

Mahieu-Williame²,

Hébert³

et al. 2019

Biomed. Opt. Express

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“…Though the use of intraoperative MRI (IoMRI) may now be considered the “gold standard”, it prolongs surgical time [ 30 ]. On the other hand, IoUS remains a reliable, real-time imaging tool, which improves surgical resection [ 31 – 35 ], while reducing the length of surgery (LOSx) compared with IoMRI. Surgeon expertise with its interpretation, however, is important for its success.…”

Section: Introductionmentioning

confidence: 99%

Surgical strategies for older patients with glioblastoma

et al. 2021

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Objective While adjuvant treatment regimens have been modified for older patients with glioblastoma (GBM), surgical strategies have not been tailored. Methods Clinical data of 48 consecutive patients aged 70 years or older, who underwent surgical resection for GBM with intraoperative ultrasonography (IoUS) alone or combination with intraoperative MRI (IoMRI) at Yale New Haven Hospital were retrospectively reviewed. Variables were analyzed, and comparative analyses were performed. Results The addition of IoMRI was not superior to IoUS alone in terms of overall survival (OS) (P = 0.306), Karnofsky Performance Score (KPS) at postoperative 6 weeks (P = 0.704) or extent of resection (P = 0.263). Length of surgery (LOSx), however, was significantly longer (P = 0.0002) in the IoMRI group. LOSx (P = 0.015) and hospital stay (P = 0.025) were predictors of postoperative complications. Increased EOR (GTR or NTR) (P = 0.030), postoperative adjuvant treatment (P < 0.0001) and postoperative complications (P = 0.006) were predictive for OS. Patients with relatively lower preoperative KPS scores (<70) showed significant improvement at postoperative 6 weeks (P<0.0001). Patients with complications (P = 0.038) were more likely to have lower KPS at postoperative 6 weeks. Conclusions Aggressive management with surgical resection should be considered in older patients with GBM, even those with relatively poor KPS. The use of ioMRI in this population does not appear to confer any measurable benefit over ioUS in experienced hands, but prolongs the length of surgery significantly, which is a preventable prognostic factor for impeding care.

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“…The technique of iMRI offers a unique method to monitor brain shift, register whenever necessary, and to quantitative the residual tumoral volume, then using this data to decide whether further resection is necessary or not. Some authors have demonstrated that the use of iMRI achieved higher rate of GTR and significantly improved survival compared with conventional surgery using intraoperative neuronavigation alone [ 28 – 31 ]. Furthermore, Coburger et al [ 32 ] even found that combining 5-ALA with iMRI achieved GTR in 100% of patients compared with 82% when using iMRI alone.…”

Section: Discussionmentioning

confidence: 99%

What is the advance of extent of resection in glioblastoma surgical treatment—a systematic review

Wang

Liang

et al. 2019

Chin Neurosurg Jl

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Glioblastoma multiform (GBM) is the most common malignant brain tumor characterized by poor prognosis, increased invasiveness, and high relapse rates. The relative survival estimates are quite low in spite of the standard treatment for GBM in recent years. Now, it has been gradually accepted that the amount of tumor mass removed correlates with longer survival rates. Although new technique advances allowing intraoperative analysis of tumor and normal brain tissue and functional paradigms based on stimulation techniques to map eloquent areas have been used for GBM resection, visual identification of tumor margins still remains a challenge for neurosurgeons. This article attempts to review and summarize the evolution of surgical resection for glioblastomas.

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Advances in Glioblastoma Operative Techniques

Cited by 21 publications

References 87 publications

Spectral complexity of 5-ALA induced PpIX fluorescence in guided surgery: a clinical study towards the discrimination of healthy tissue and margin boundaries in high and low grade gliomas

Spectral complexity of 5-ALA induced PpIX fluorescence in guided surgery: a clinical study towards the discrimination of healthy tissue and margin boundaries in high and low grade gliomas

Surgical strategies for older patients with glioblastoma

What is the advance of extent of resection in glioblastoma surgical treatment—a systematic review

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