Intraoperative Computed Tomography and Awake Craniotomy: A Useful and Safe Combination in Brain Surgery

Barbagallo, Giuseppe; Morrone, Antonio; Certo, Francesco

doi:10.1016/j.wneu.2018.07.078

Cited by 17 publications

(8 citation statements)

References 13 publications

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“…able to confirm the target lesion under microscope and compare the fusion image with target point. Because of the reduction in tumor volume during the surgery, the tumor and its surrounding environment were altered; therefore, intraoperative CT was performed to identify shifts in the brain lesion relative to the fusion image [14,15]. Fluorescence dye (5-ALA: 5-aminolevulinic acid) was used to discriminate the tumorous lesion in all surgical resection cases.…”

Section: Plos Onementioning

confidence: 99%

Maximal surgical resection and adjuvant surgical technique to prolong the survival of adult patients with thalamic glioblastoma

et al. 2021

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The importance of maximal resection in the treatment of glioblastoma (GBM) has been reported in many studies, but maximal resection of thalamic GBM is rarely attempted due to high rate of morbidity and mortality. The purpose of this study was to investigate the role of surgical resection in adult thalamic glioblastoma (GBM) treatment and to identify the surgical technique of maximal safety resection. In case of suspected thalamic GBM, surgical resection is the treatment of choice in our hospital. Biopsy was considered when there was ventricle wall enhancement or multiple enhancement lesion in a distant location. Navigation magnetic resonance imaging, diffuse tensor tractography imaging, tailed bullets, and intraoperative computed tomography and neurophysiologic monitoring (transcranial motor evoked potential and direct subcortical stimulation) were used in all surgical resection cases. The surgical approach was selected on the basis of the location of the tumor epicenter and the adjacent corticospinal tract. Among the 42 patients, 19 and 23 patients underwent surgical resection and biopsy, respectively, according to treatment strategy criteria. As a result, the surgical resection group exhibited a good response with overall survival (OS) (median: 676 days, p < 0.001) and progression-free survival (PFS) (median: 328 days, p < 0.001) compared with each biopsy groups (doctor selecting biopsy group, median OS: 240 days and median PFS: 134 days; patient selecting biopsy group, median OS: 212 days and median PFS: 118 days). The surgical resection groups displayed a better prognosis compared to that of the biopsy groups for both the O6-methylguanine-DNA methyltransferase unmethylated (log-rank p = 0.0035) or methylated groups (log-rank p = 0.021). Surgical resection was significantly associated with better prognosis (hazard ratio: 0.214, p = 0.006). In case of thalamic GBM without ventricle wall-enhancing lesion or multiple lesions, maximal surgical resection above 80% showed good clinical outcomes with prolonged the overall survival compared to biopsy. It is helpful to use adjuvant surgical techniques of checking intraoperative changes and select the appropriate surgical approach for reducing the surgical morbidity.

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Section: Plos Onementioning

confidence: 99%

Maximal surgical resection and adjuvant surgical technique to prolong the survival of adult patients with thalamic glioblastoma

et al. 2021

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“…Our multimodal intraoperative protocol has already been described. 9,13 After craniotomy and before dural opening, navigated iUS acquisition was performed. All patients underwent neuronavigated 5-ALA fluorescenceguided microsurgical tumor resection.…”

Section: Methodsmentioning

confidence: 99%

“…The use of iCT is also feasible in awake craniotomies. 13 iCT is particularly useful to identify tumor remnants, by comparison of contrast-enhanced pre-and intraoperative (postresection) scans, and to rule out early postoperative complications such as hemorrhage. 9…”

Section: Ict In Recurrent Hgg Surgerymentioning

confidence: 99%

Recurrent high-grade glioma surgery: a multimodal intraoperative protocol to safely increase extent of tumor resection and analysis of its impact on patient outcome

Barbagallo

Certo

Gregorio

et al. 2021

Neurosurgical Focus

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OBJECTIVENo consensus exists on the best treatment for recurrent high-grade glioma (HGG), particularly in terms of surgical indications, and scant data are available on the integrated use of multiple technologies to overcome intraoperative limits and pitfalls related to artifacts secondary to previous surgery and radiotherapy. Here, the authors report on their experience with the integration of multiple intraoperative tools in recurrent HGG surgery, analyzing their pros and cons as well as their effectiveness in increasing the extent of tumor resection. In addition, they present a review of the relevant literature on this topic.METHODSThe authors reviewed all cases in which recurrent HGG had been histologically diagnosed after a first surgery and the patient had undergone a second surgery involving neuronavigation with MRI, intraoperative CT (iCT), 11C-methionine–positron emission tomography (11C-MET-PET), 5-aminolevulinic acid (5-ALA) fluorescence, intraoperative neurophysiological monitoring (IONM), and intraoperative navigated ultrasound (iUS). All cases were classified according to tumor functional grade (1, noneloquent area; 2, near an eloquent area; 3, eloquent area).RESULTSTwenty patients with recurrent HGG were operated on using a multimodal protocol. The recurrent tumor functional grade was 1 in 4 patients, 2 in 8 patients, and 3 in the remaining 8 patients. In all patients but 2, 100% EOTR was obtained. Intraoperative 5-ALA fluorescence and navigated iUS showed low specificity and sensitivity. iCT detected tumor remnants in 3 cases. Postoperatively, 6 patients (30%) had worsening neurological conditions: 4 recovered within 90 days, 1 partially recovered, and 1 experienced a permanent deficit. The median Karnofsky Performance Status remained substantially unchanged over the follow-up period. The mean progression-free survival after the second surgery was 7.7 months (range 2–11 months). The mean overall survival was 25.4 months (range 10–52 months), excluding 2 long survivors. Two patients died within 60 days after surgery, and 3 patients were still under follow-up at the end of this study.CONCLUSIONSThis is the first study reporting the integration of neuronavigation, 5-ALA fluorescence, iUS, iCT, 11C-MET-PET, and IOM during microsurgical resection of recurrent glioma. The authors believe that the proposed multimodal protocol is useful to increase the safety, effectiveness, and EOTR in patients with recurrent HGG and brain alterations secondary to radio- and chemotherapy.

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“…Otras herramientas, como la RM intraoperatoria, han demostrado ser útiles para lograr resecciones más amplias, pero no garantizan que se respeten las áreas elocuentes durante la cirugía y el tiempo de realización de la RM puede ser de hasta 30 minutos, por lo que es dificil mantener al paciente despierto y tranquilo durante el mapeo. Barbagallo, et al 24 reportan una serie de casos utilizando la tomografía intraoperatoria para verificar la máxima resección posible y ajustar la navegación, ya que después de iniciar la resección por la pérdida de volumen se genera el fenómeno llamado brain shift, que hace que el registro del navegador sea menos preciso. En este estudio se utilizó el mapeo con paciente despierto para verificar las áreas funcionales.…”

Section: B a Cunclassified

Cirugía despierta con mapeo cortico-subcortical en gliomas difusos adyacentes al lóbulo central. Reporte de dos casos y revisión de la literatura

Núñez-Velasco¹,

Avendaño-Méndez-Padilla²,

García-Iturbide³

et al. 2019

CIRU

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Intraoperative Computed Tomography and Awake Craniotomy: A Useful and Safe Combination in Brain Surgery

Cited by 17 publications

References 13 publications

Maximal surgical resection and adjuvant surgical technique to prolong the survival of adult patients with thalamic glioblastoma

Maximal surgical resection and adjuvant surgical technique to prolong the survival of adult patients with thalamic glioblastoma

Recurrent high-grade glioma surgery: a multimodal intraoperative protocol to safely increase extent of tumor resection and analysis of its impact on patient outcome

Cirugía despierta con mapeo cortico-subcortical en gliomas difusos adyacentes al lóbulo central. Reporte de dos casos y revisión de la literatura

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