Resection of gliomas deemed inoperable by neurosurgeons based on preoperative imaging studies
| العنوان: | Resection of gliomas deemed inoperable by neurosurgeons based on preoperative imaging studies |
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| المؤلفون: | Harjus Birk, Mitchel S. Berger, Seunggu J. Han, Jeffrey W. Sall, Derek G. Southwell, Jing Li |
| المصدر: | Journal of Neurosurgery. 129:567-575 |
| بيانات النشر: | Journal of Neurosurgery Publishing Group (JNSPG), 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Biopsy, Population, Conscious Sedation, Resection, Lesion, Young Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Glioma, Preoperative Care, Humans, Medicine, Karnofsky Performance Status, education, Intersectoral Collaboration, Aged, Retrospective Studies, Brain Mapping, education.field_of_study, medicine.diagnostic_test, business.industry, Brain biopsy, Brain, Supratentorial Neoplasms, General Medicine, Middle Aged, Partial resection, medicine.disease, Magnetic Resonance Imaging, Electric Stimulation, Surgery, 030220 oncology & carcinogenesis, Radiological weapon, Female, Interdisciplinary Communication, medicine.symptom, business, 030217 neurology & neurosurgery, Follow-Up Studies, Preoperative imaging |
| الوصف: | OBJECTIVEMaximal safe resection is a primary objective in the management of gliomas. Despite this objective, surgeons and referring physicians may, on the basis of radiological studies alone, assume a glioma to be unresectable. Because imaging studies, including functional MRI, may not localize brain functions (such as language) with high fidelity, this simplistic approach may exclude some patients from what could be a safe resection. Intraoperative direct electrical stimulation (DES) allows for the accurate localization of functional areas, thereby enabling maximal resection of tumors, including those that may appear inoperable based solely on radiological studies. In this paper the authors describe the extent of resection (EOR) and functional outcomes following resections of tumors deemed inoperable by referring physicians and neurosurgeons.METHODSThe authors retrospectively examined the cases of 58 adult patients who underwent glioma resection within 6 months of undergoing a brain biopsy of the same lesion at an outside hospital. All patients exhibited unifocal supratentorial disease and preoperative Karnofsky Performance Scale scores ≥ 70. The EOR and 6-month functional outcomes for this population were characterized.RESULTSIntraoperative DES mapping was performed on 96.6% (56 of 58) of patients. Nearly half of the patients (46.6%, 27 of 58) underwent an awake surgical procedure with DES. Overall, the mean EOR was 87.6% ± 13.6% (range 39.0%–100%). Gross-total resection (resection of more than 99% of the preoperative tumor volume) was achieved in 29.3% (17 of 58) of patients. Subtotal resection (95%–99% resection) and partial resection (PR; < 95% resection) were achieved in 12.1% (7 of 58) and 58.6% (34 of 58) of patients, respectively. Of the cases that involved PR, the mean EOR was 79.4% ± 12.2%. Six months after surgery, no patient was found to have a new postoperative neurological deficit. The majority of patients (89.7%, 52 of 58) were free of neurological deficits both pre- and postoperatively. The remainder of patients exhibited either residual but stable deficits (5.2%, 3 of 58) or complete correction of preoperative deficits (5.2%, 3 of 58).CONCLUSIONSThe use of DES enabled maximal safe resections of gliomas deemed inoperable by referring neurosurgeons. With rare exceptions, tumor resectability cannot be determined solely by radiological studies. |
| تدمد: | 1933-0693 0022-3085 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4feaa294f32e7fa4d10afe527a8236da https://doi.org/10.3171/2017.5.jns17166 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....4feaa294f32e7fa4d10afe527a8236da |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 19330693 00223085 |
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