BACKGROUND: Only few data are available on the specific topic of 5-aminolevulinic acid (5-ALA) guided surgery of high-grade gliomas (HGG) located in eloquent areas. Studies focusing specifically on the post-operative clinical outcome of such patients are yet not available, and it has not been so far explored whether such approach could be more suitable for some particular subgroups of patients. METHODS: Patients affected by HGG in eloquent areas who underwent surgery assisted by 5-ALA fluorescence and intra-operative monitoring were prospectively recruited in our Department between June 2011 and August 2012. Resection rate was reported as complete resection of enhancing tumor (CRET), gross total resection (GTR) >98 % and GTR > 90 %. Clinical outcome was evaluated at 7, 30, and 90 days after surgery. RESULTS: Thirty-one patients were enrolled. Resection was complete (CRET) in 74 % of patients. Tumor removal was stopped to avoid neurological impairment in 26 % of cases. GTR > 98 % and GTR > 90 % was achieved in 93 % and 100 % of cases, respectively. First surgery and awake surgery had a CRET rate of 80 % and 83 %, respectively. Even though at the first-week assessment 64 % of patients presented neurological impairment, there was a 3 % rate of severe morbidity at the 90th day assessment. Newly diagnosed patients had a significantly lower morbidity (0 %) and post-operative higher median KPS. Both pre-operative neurological condition and improvement after corticosteroids resulted significantly predictive of post-operative functional outcome. CONCLUSIONS: 5-ALA surgery assisted by functional mapping makes high HGG resection in eloquent areas feasible , through a reasonable rate of late morbidity. This emerges even more remarkably for selected patients.
BACKGROUND: Only few data are available on the specific topic of 5-aminolevulinic acid (5-ALA) guided surgery of high-grade gliomas (HGG) located in eloquent areas. Studies focusing specifically on the post-operative clinical outcome of such patients are yet not available, and it has not been so far explored whether such approach could be more suitable for some particular subgroups of patients. METHODS:Patients affected by HGG in eloquent areas who underwent surgery assisted by 5-ALA fluorescence and intra-operative monitoring were prospectively recruited in our Department between June 2011 and August 2012. Resection rate was reported as complete resection of enhancing tumor (CRET), gross total resection (GTR) >98 % and GTR > 90 %. Clinical outcome was evaluated at 7, 30, and 90 days after surgery. RESULTS: Thirty-one patients were enrolled. Resection was complete (CRET) in 74 % of patients. Tumor removal was stopped to avoid neurological impairment in 26 % of cases. GTR > 98 % and GTR > 90 % was achieved in 93 % and 100 % of cases, respectively. First surgery and awake surgery had a CRET rate of 80 % and 83 %, respectively. Even though at the first-week assessment 64 % of patients presented neurological impairment, there was a 3 % rate of severe morbidity at the 90th day assessment. Newly diagnosed patients had a significantly lower morbidity (0 %) and post-operative higher median KPS. Both pre-operative neurological condition and improvement after corticosteroids resulted significantly predictive of post-operative functional outcome. CONCLUSIONS:5-ALA surgery assisted by functional mapping makes high HGG resection in eloquent areas feasible , through a reasonable rate of late morbidity. This emerges even more remarkably for selected patients.
Authors: Tiara S Napier; Neha Udayakumar; Aditi H Jani; Yolanda E Hartman; Hailey A Houson; Lindsay Moore; Hope M Amm; Nynke S van den Berg; Anna G Sorace; Jason M Warram Journal: Mol Cancer Ther Date: 2020-06-30 Impact factor: 6.261
Authors: Marta Rossetto; Pietro Ciccarino; Giuseppe Lombardi; Giuseppe Rolma; Diego Cecchin; Alessandro Della Puppa Journal: Neurosurg Rev Date: 2015-07-17 Impact factor: 3.042
Authors: S H Chen; J Yang; H B Han; D H Cui; J J Sun; C C Ma; Q Y He; G Z Lin; Y F Han; C Wu; K M Ma; Y B Zhang Journal: Beijing Da Xue Xue Bao Yi Xue Ban Date: 2019-06-18
Authors: J Scott Cordova; Saumya S Gurbani; Chad A Holder; Jeffrey J Olson; Eduard Schreibmann; Ran Shi; Ying Guo; Hui-Kuo G Shu; Hyunsuk Shim; Costas G Hadjipanayis Journal: Mol Imaging Biol Date: 2016-06 Impact factor: 3.488