Giuseppe M V Barbagallo1,2, Stefano Palmucci3, Massimiliano Visocchi4, Sabrina Paratore5, Giancarlo Attinà3, Giuseppe Sortino3, Vincenzo Albanese1, Francesco Certo1. 1. Department of Neurosurgery, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy. 2. Interdisciplinary Research Centre on Diagnosis and Treatment of Brain Tumors, University of Catania, Catania, Italy. 3. Department of Radiodiagnostic and Oncological Radiotherapy, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy. 4. Institute of Neurosurgery, Catholic University, Rome, Italy. 5. Department of Anatomic Pathology, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy.
Abstract
BACKGROUND: Intraoperative magnetic resonance imaging is the gold standard among image-guided techniques for glioma surgery. Scant data are available on the role of intraoperative computed tomography (i-CT) in high-grade glioma (HGG) surgery. OBJECTIVE: To verify the technical feasibility and usefulness of portable i-CT in image-guided surgical resection of HGGs. METHODS: This is a retrospective series control analysis of prospectively collected data. Twenty-five patients (Group A) with HGGs underwent surgery using i-CT and 5-aminolevulinic acid (5-ALA) fluorescence. A second cohort of 25 patients (Group B) underwent 5-ALA fluorescence-guided surgery but without i-CT. We used a portable 8-slice CT scanner and, in both groups, neuronavigation. Extent of tumor resection (ETOR) and pre- and postoperative Karnofsky performance status (KPS) scores were measured; the impact of i-CT on overall survival (OS) and progression-free survival (PFS) was also analyzed. RESULTS: In 8 patients (32%) in Group A, i-CT revealed residual tumor, and in 4 of them it helped to also resect pathological tissue detached from the main tumor. EOTR in these 8 patients was 97.3% (96%-98.6%). In Group B, residual tumor was found in 6 patients, whose tumor's mean resection was 98% (93.5-99.7). The Student t test did not show statistically significant differences in EOTR in the 2 groups. The KPS score decreased from 67 to 69 after surgery in Group A and from 74 to 77 in Group B (P = .07 according to the Student t test). Groups A and B did not show statistically significant differences in OS and PFS (P = .61 and .46, respectively, by the log-rank test). CONCLUSION: No statistically significant differences in EOTR, KPS, PFS, and OS were observed in the 2 groups. However, i-CT helped to verify EOTR and to update the neuronavigator with real-time images, as well as to identify and resect pathological tissue in multifocal tumors. i-CT is a feasible and effective alternative to intraoperative magnetic resonance imaging. Portable i-CT can provide useful real-time information during brain surgery and can be easily introduced in neurosurgical theaters in daily practice.
BACKGROUND: Intraoperative magnetic resonance imaging is the gold standard among image-guided techniques for glioma surgery. Scant data are available on the role of intraoperative computed tomography (i-CT) in high-grade glioma (HGG) surgery. OBJECTIVE: To verify the technical feasibility and usefulness of portable i-CT in image-guided surgical resection of HGGs. METHODS: This is a retrospective series control analysis of prospectively collected data. Twenty-five patients (Group A) with HGGs underwent surgery using i-CT and 5-aminolevulinic acid (5-ALA) fluorescence. A second cohort of 25 patients (Group B) underwent 5-ALA fluorescence-guided surgery but without i-CT. We used a portable 8-slice CT scanner and, in both groups, neuronavigation. Extent of tumor resection (ETOR) and pre- and postoperative Karnofsky performance status (KPS) scores were measured; the impact of i-CT on overall survival (OS) and progression-free survival (PFS) was also analyzed. RESULTS: In 8 patients (32%) in Group A, i-CT revealed residual tumor, and in 4 of them it helped to also resect pathological tissue detached from the main tumor. EOTR in these 8 patients was 97.3% (96%-98.6%). In Group B, residual tumor was found in 6 patients, whose tumor's mean resection was 98% (93.5-99.7). The Student t test did not show statistically significant differences in EOTR in the 2 groups. The KPS score decreased from 67 to 69 after surgery in Group A and from 74 to 77 in Group B (P = .07 according to the Student t test). Groups A and B did not show statistically significant differences in OS and PFS (P = .61 and .46, respectively, by the log-rank test). CONCLUSION: No statistically significant differences in EOTR, KPS, PFS, and OS were observed in the 2 groups. However, i-CT helped to verify EOTR and to update the neuronavigator with real-time images, as well as to identify and resect pathological tissue in multifocal tumors. i-CT is a feasible and effective alternative to intraoperative magnetic resonance imaging. Portable i-CT can provide useful real-time information during brain surgery and can be easily introduced in neurosurgical theaters in daily practice.
Authors: Giuseppe Maria Vincenzo Barbagallo; Roberto Altieri; Marco Garozzo; Massimiliano Maione; Stefania Di Gregorio; Massimiliano Visocchi; Simone Peschillo; Pasquale Dolce; Francesco Certo Journal: Front Oncol Date: 2021-02-24 Impact factor: 6.244
Authors: Giuseppe Broggi; Francesco Certo; Roberto Altieri; Rosario Caltabiano; Marco Gessi; Giuseppe Maria Vincenzo Barbagallo Journal: Surg Neurol Int Date: 2021-09-20
Authors: Benjamin Saß; Mirza Pojskic; Darko Zivkovic; Barbara Carl; Christopher Nimsky; Miriam H A Bopp Journal: Front Oncol Date: 2021-08-18 Impact factor: 6.244
Authors: Nils Hecht; Marcus Czabanka; Paul Kendlbacher; Julia-Helene Raff; Georg Bohner; Peter Vajkoczy Journal: Acta Neurochir (Wien) Date: 2020-03-19 Impact factor: 2.216