Improvement of functional outcome after radical surgery in glioblastoma patients: the efficacy of a navigation-guided fence-post procedure and neurophysiological monitoring

Abstract

This retrospective study investigated the functional outcomes of patient with glioblastoma receiving radical surgery before and after the adoption of the navigation-guided fence-post (NGFP) procedure and neurophysiological monitoring. We investigated 42 glioblastoma patients receiving radical surgery in our institute between 1980 and 2005. Of the 42 patients, 18 patients from 1980 to 1996 (1st term) underwent radical surgery without navigation system guidance, NGFP, or neurophysiological monitoring; 11 patients from 1997 to 2002 (2nd term) underwent surgery with simple navigation system guidance but without NGFP procedure or neurophysiological monitoring, and 13 patients from 2003 to 2005 (3rd term) underwent surgery with the NGFP procedure and neurophysiological monitoring as appropriate. There were no significance differences between any of the three term groups in age, gender, preoperative KPS score, or 'surgical staging for glioma' according to the difficulty of surgery. The rates of 95% or greater volume reduction in each term were 38.9%, 54.5% and 76.9%. The rates of morbidity were 38.9%, 18.1% and 0%. The change in KPS scores (delta KPS) before and after the perioperative period in each term were -16.1 +/- 6.6 SEM, -9.0 +/- 5.8 SEM and +8.5 +/- 3.7 SEM, respectively. The delta KPS in the 3rd term was significantly better than those of 1st and 2nd terms (P < 0.01, Kruskal-Wallis rank test). The rate of patients who were discharged to home and who resumed daily useful life without assistance was 38.9%, 63.6% and 84.6% in each term, respectively. The mean survival times in each term were 9.9, 14.0 and 16.8 months. The introduction of the NGFP procedure and neurophysiological monitoring in glioblastoma radical surgery improved the functional outcome of patients.

Hypoxic glucose metabolism in glioblastoma as a potential prognostic factor

“…At least, the tissue showing the highest tracer uptake was carefully resected. To determine the resection boundary, three or four silicon catheters were inserted around the targeted lesion under the guidance of a navigation system before dural opening to avoid inaccuracy caused by brain shift [23]. After insertion of these catheter tubes, we performed a dural incision and resected as much tumor tissue as possible under the guidance of the catheter tubes, as well as other neurophysiological monitoring.…”

Intraoperative Navigation and Fluorescence Imagings in Malignant Glioma Surgery

“…Actually, it has been reported that intraoperative neuronavigation in glioma surgery improves functional outcomes of glioma patients. 24,25 However, there are still problems that remain to be resolved. The biggest of these is that navigation surgery can only minimally deal with 'brain shift'.…”

Motor Evoked Potentials in Supratentorial Glioma Surgery

“…This inding was then exploited for the development of intraoperative neuromonitoring techniques that involve MEPs induced via both direct cortical and transcranial cortical electrical stimulation and direct subcortical white mater stimulation [7][8][9]. Since then, the intraoperative use of MEPs has substantially contributed to improved functional outcomes of glioma patients [10] as well as pushing the boundaries of surgery for lesions considered inoperable in the pre-MEP era [6].…”