Format

Send to

Choose Destination
Oper Neurosurg (Hagerstown). 2019 Aug 21. pii: opz203. doi: 10.1093/ons/opz203. [Epub ahead of print]

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

Author information

1
Division of Neurosurgery, University of Geneva Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
2
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta," Milan, Italy.
3
Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia.
4
Focused Ultrasound Foundation, Charlottesville, Virginia.
5
Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, Canada.
6
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
7
Group of CNS Angiogenesis and Neurovascular Link, Physician-Scientist Program, Institute for Regenerative Medicine, Neuroscience Center Zurich, University Hospital Zurich, Zurich, Switzerland.
8
Division of Neurosurgery, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH), University Hospital Zurich, Zurich, Switzerland.
9
Department of Fundamental Neurobiology, Krembil Research Institute, University of Toronto, Toronto, Canada.
10
Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Canada.
11
Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
12
Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, Maryland.

Abstract

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.

KEYWORDS:

Extent of resection; Gliomas; High-grade gliomas; Intraoperative ultrasound; Neuronavigation; Patient outcome; Residual tumor volume

PMID:
31435672
DOI:
10.1093/ons/opz203

Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center