Navigated Intraoperative 2-Dimensional Ultrasound in High-Grade Glioma Surgery: Impact on Extent of Resection and Patient Outcome.

Oper Neurosurg (Hagerstown) 2019 Aug 21. Epub 2019 Aug 21.

Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta," Milan, Italy.

Background: Maximizing extent of resection (EOR) and reducing residual tumor volume (RTV) while preserving neurological functions is the main goal in the surgical treatment of gliomas. Navigated intraoperative ultrasound (N-ioUS) combining the advantages of ultrasound and conventional neuronavigation (NN) allows for overcoming the limitations of the latter.

Objective: To evaluate the impact of real-time NN combining ioUS and preoperative magnetic resonance imaging (MRI) on maximizing EOR in glioma surgery compared to standard NN.

Methods: We retrospectively reviewed a series of 60 cases operated on for supratentorial gliomas: 31 operated under the guidance of N-ioUS and 29 resected with standard NN. Age, location of the tumor, pre- and postoperative Karnofsky Performance Status (KPS), EOR, RTV, and, if any, postoperative complications were evaluated.

Results: The rate of gross total resection (GTR) in NN group was 44.8% vs 61.2% in N-ioUS group. The rate of RTV > 1 cm3 for glioblastomas was significantly lower for the N-ioUS group (P < .01). In 13/31 (42%), RTV was detected at the end of surgery with N-ioUS. In 8 of 13 cases, (25.8% of the cohort) surgeons continued with the operation until complete resection. Specificity was greater in N-ioUS (42% vs 31%) and negative predictive value (73% vs 54%). At discharge, the difference between pre- and postoperative KPS was significantly higher for the N-ioUS (P < .01).

Conclusion: The use of an N-ioUS-based real-time has been beneficial for resection in noneloquent high-grade glioma in terms of both EOR and neurological outcome, compared to standard NN. N-ioUS has proven usefulness in detecting RTV > 1 cm3.

Download full-text PDF

Source
http://dx.doi.org/10.1093/ons/opz203DOI Listing
August 2019

Publication Analysis

Top Keywords

glioma surgery
8
n-ious group
8
extent resection
8
navigated intraoperative
8
reviewed series
4
series cases
4
retrospectively reviewed
4
standard nnmethods
4
surgery compared
4
compared standard
4
nnmethods retrospectively
4
cases operated
4
guidance n-ious
4
n-ious resected
4
operated guidance
4
gliomas operated
4
operated supratentorial
4
supratentorial gliomas
4
eor glioma
4
mri maximizing
4

References

(Supplied by CrossRef)
The value of glioma extent of resection in the modern neurosurgical era
Hardesty et al.
Front Neur 2012
Role of surgical resection in low- and high-grade gliomas
Hervey-Jumper et al.
Curr Treat Options Neurol 2014
Recent surgical management of gliomas
Sanai et al.
Adv Exp Med Biol 2012

Similar Publications