Experiences in surgery of primary malignant brain tumours in the primary sensori-motor cortex practical recommendations and results of a single institution

Noell, Susan; Feigl, Guenther C.; Naros, Georgios; Barking, Susanne; Tatagiba, Marcos; Ritz, Rainer

doi:10.1016/j.clineuro.2015.05.021

Cited by 20 publications

(16 citation statements)

References 31 publications

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“…Sixty-four studies describe the clinical use of fluorescent agents [1, 3, 5, 6, 9, 11, 13–16, 22–26, 28–31, 33–35, 37, 38, 40–42, 44, 49, 52–54, 58, 64–66, 69, 71, 74, 75, 78, 80–82, 84–87, 89, 92, 94, 97–101, 105–107, 109, 110, 113, 115, 118]. Three ways of labeling tumor cells were identified in the literature: (1) passive, (2) metabolic, and (3) molecular labeling.…”

Section: Resultsmentioning

confidence: 99%

“…Forty-four clinical studies described the use of 5-ALA for glioma surgery [3, 5, 6, 13–16, 22, 24–26, 28, 30, 31, 33, 34, 37, 40–42, 44, 66, 69, 74, 75, 78, 81, 82, 84, 85, 87, 89, 94, 97–101, 105, 106, 109, 110, 113, 115], of which only six studies included LGGs [28, 33, 84, 109, 110, 113]. 5-ALA is the only fluorescent agent that has been tested in an RCT.…”

Section: Resultsmentioning

confidence: 99%

“…The study by Stummer et al showed a higher GTR rate for the 5-ALA group compared to the group that was operated without 5-ALA (65 vs. 35%) [99]. In observational studies, the rate of GTR after 5-ALA administration ranges from 25 to 94.3% for HGGs [3, 5, 6, 14, 16, 22, 24, 25, 30, 31, 34, 40, 42, 44, 69, 75, 82, 87, 89, 94, 98, 99, 105, 106, 113]. However, studies that included a control group all confirm a significantly higher GTR rate in the FGS group [14, 24, 82, 94, 99].…”

Section: Resultsmentioning

confidence: 99%

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Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

et al. 2016

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BackgroundFluorescence-guided surgery (FGS) is a technique used to enhance visualization of tumor margins in order to increase the extent of tumor resection in glioma surgery. In this paper, we systematically review all clinically tested fluorescent agents for application in FGS for glioma and all preclinically tested agents with the potential for FGS for glioma.MethodsWe searched the PubMed and Embase databases for all potentially relevant studies through March 2016. We assessed fluorescent agents by the following outcomes: rate of gross total resection (GTR), overall and progression-free survival, sensitivity and specificity in discriminating tumor and healthy brain tissue, tumor-to-normal ratio of fluorescent signal, and incidence of adverse events.ResultsThe search strategy resulted in 2155 articles that were screened by titles and abstracts. After full-text screening, 105 articles fulfilled the inclusion criteria evaluating the following fluorescent agents: 5-aminolevulinic acid (5-ALA) (44 studies, including three randomized control trials), fluorescein (11), indocyanine green (five), hypericin (two), 5-aminofluorescein-human serum albumin (one), endogenous fluorophores (nine) and fluorescent agents in a pre-clinical testing phase (30). Three meta-analyses were also identified.Conclusions5-ALA is the only fluorescent agent that has been tested in a randomized controlled trial and results in an improvement of GTR and progression-free survival in high-grade gliomas. Observational cohort studies and case series suggest similar outcomes for FGS using fluorescein. Molecular targeting agents (e.g., fluorophore/nanoparticle labeled with anti-EGFR antibodies) are still in the pre-clinical phase, but offer promising results and may be valuable future alternatives.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

et al. 2016

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“…On the other hand, another published study reported surgical results in 29 cases of malignant glioma in the primary sensorimotor cortex. 15 In those cases tumor resection was performed with continuous transcranial MEP monitoring, electrical stimulation for motor mapping, and 5-aminolevulinic acid fluorescence guidance without awake craniotomy. The authors reported that a deterioration in motor function was seen in only 16% of patients.…”

Section: Feasibility Of Resection Of Gliomas In the Precentral Gyrusmentioning

confidence: 99%

Awake craniotomy with transcortical motor evoked potential monitoring for resection of gliomas in the precentral gyrus: utility for predicting motor function

Saito¹,

Muragakı

Tamura

et al. 2020

Journal of Neurosurgery

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S urgery of a glioma in the precentral gyrus carries a risk of critical motor dysfunctions, and thus adequate resection is difficult to achieve. An aggressive surgical strategy has been widely accepted and contributed to a definite improvement in outcomes after treatment for World Health Organization (WHO) grade II, 14,22 III, 3 and IV 4,9,21 gliomas. On the other hand, glioma patients have a limited life expectancy. Long-lasting neurological deficits associated with surgical removal affect daily life and cause additional distress. To minimize permanent se-ABBREVIATIONS CMAP = compound muscle action potential; DWI = diffusion-weighted imaging; EOR = extent of resection; IVM = intraoperative voluntary movement; MEP = motor evoked potential; WHO = World Health Organization.OBJECTIVE Resection of gliomas in the precentral gyrus carries a risk of severe motor dysfunction. To prevent permanent, severe postoperative motor dysfunction, reliable intraoperative predictors of postoperative function are required. Since 2005, the authors have removed gliomas in the precentral gyrus with combined functional mapping and estimation of intraoperative voluntary movement (IVM) during awake craniotomy and transcortical motor evoked potentials (MEPs).The purpose of the current study was to evaluate whether intraoperative findings of combined monitoring of IVM during awake craniotomy and transcortical MEP monitoring were useful for predicting postoperative motor function of patients with gliomas in the precentral gyrus. METHODS The current study included 30 patients who underwent resection of precentral gyrus gliomas during awake craniotomy from April 2000 to January 2018. All tumors were removed with monitoring of IVM during awake craniotomy and transcortical MEPs. Postoperative motor function was classified as stable or declined, with the extent of decline categorized as mild, moderate, or severe. We defined moderate and severe deficits were those that hindered daily life. RESULTS In 28 of 30 cases, available waveforms were obtained with transcortical MEPs. The mean extent of resection (EOR) was 93%. Relative to preoperative status, motor function 6 months after surgery was considered stable in 20 patients and was considered to show mild decline in 7, moderate decline in 2, and severe decline in 1. Motor function 6 months after surgery was significantly correlated with IVM (p = 0.0096), changes in transcortical MEPs (decline ≤ or > 50%) (p = 0.0163), EOR, and ischemic lesions on postoperative MRI. Six patients with no change in IVM showed stable motor function 6 months after surgery. Only 2 patients with a decline in IVM and a decline in MEPs ≤ 50% had a decline in motor function 6 months after surgery (18%; 2/11 patients), whereas 11 patients with a decline in IVM and a decline in MEPs > 50% had such a decline in motor function (73%; 8/11 patients) including 2 patients with moderate and 1 with severe deficits. Three patients with moderate or severe motor deficits showed the lowest MEP values (< 100 µV). CONCLUSIONS Combined judgm...

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“…Studies in larger series on different tumor types reported variable extent of resection (EOR) and postoperative permanent morbidity. 7,10,17,18 More recently, evidence that the assistance of a brain mapping technique applied to M1 tumors affords an excellent resection suggests that these tumors are indeed amenable to resection and should not be labeled unresectable. 3,9 Resectability and maintenance of patient integrity depend on the ability to successfully identify motor tracts during resection.…”

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confidence: 99%

Resection of tumors within the primary motor cortex using high-frequency stimulation: oncological and functional efficiency of this versatile approach based on clinical conditions

Rossi¹,

Nibali²,

Viganò³

et al. 2020

Journal of Neurosurgery

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OBJECTIVEBrain mapping techniques allow one to effectively approach tumors involving the primary motor cortex (M1). Tumor resectability and maintenance of patient integrity depend on the ability to successfully identify motor tracts during resection by choosing the most appropriate neurophysiological paradigm for motor mapping. Mapping with a high-frequency (HF) stimulation technique has emerged as the most efficient tool to identify motor tracts because of its versatility in different clinical settings. At present, few data are available on the use of HF for removal of tumors predominantly involving M1.METHODSThe authors retrospectively analyzed a series of 102 patients with brain tumors within M1, by reviewing the use of HF as a guide. The neurophysiological protocols adopted during resections were described and correlated with patients’ clinical and tumor imaging features. Feasibility of mapping, extent of resection, and motor function assessment were used to evaluate the oncological and functional outcome to be correlated with the selected neurophysiological parameters used for guiding resection. The study aimed to define the most efficient protocol to guide resection for each clinical condition.RESULTSThe data confirmed HF as an efficient tool for guiding resection of M1 tumors, affording 85.3% complete resection and only 2% permanent morbidity. HF was highly versatile, adapting the stimulation paradigm and the probe to the clinical context. Three approaches were used. The first was a “standard approach” (HF “train of 5,” using a monopolar probe) applied in 51 patients with no motor deficit and seizure control, harboring a well-defined tumor, showing contrast enhancement in most cases, and reaching the M1 surface. Complete resection was achieved in 72.5%, and 2% had permanent morbidity. The second approach was an “increased train approach,” that is, an increase in the number of pulses (7–9) and of pulse duration, using a monopolar probe. This second approach was applied in 8 patients with a long clinical history, previous treatment (surgery, radiation therapy, chemotherapy), motor deficit at admission, poor seizure control, and mostly high-grade gliomas or metastases. Complete resection was achieved in 87.5% using this approach, along with 0% permanent morbidity. The final approach was a “reduced train approach,” which was the combined use of train of 2 or train of 1 pulses associated with the standard approach, using a monopolar or bipolar probe. This approach was used in 43 patients with a long clinical history and poorly controlled seizures, harboring tumors with irregular borders without contrast enhancement (low or lower grade), possibly not reaching the cortical surface. Complete resection was attained in 88.4%, and permanent morbidity was found in 2.3%.CONCLUSIONSResection of M1 tumors is feasible and safe. By adapting the stimulation paradigm and probe appropriately to the clinical context, the best resection and functional results can be achieved.

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Experiences in surgery of primary malignant brain tumours in the primary sensori-motor cortex practical recommendations and results of a single institution

Cited by 20 publications

References 31 publications

Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

Agents for fluorescence-guided glioma surgery: a systematic review of preclinical and clinical results

Awake craniotomy with transcortical motor evoked potential monitoring for resection of gliomas in the precentral gyrus: utility for predicting motor function

Resection of tumors within the primary motor cortex using high-frequency stimulation: oncological and functional efficiency of this versatile approach based on clinical conditions

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