Hans Kristian Bø1,2, Ole Solheim3,4, Kjell-Arne Kvistad5, Erik Magnus Berntsen2,5, Sverre Helge Torp6,7, Anne Jarstein Skjulsvik6,7, Ingerid Reinertsen8, Daniel Høyer Iversen2,8, Geirmund Unsgård3,4, Asgeir Store Jakola3,9,10. 1. 1Department of Diagnostic Imaging, Nordland Hospital Trust, Bodø. 2. Departments of2Circulation and Medical Imaging. 3. Departments of3Neurosurgery. 4. 4Neuromedicine and Movement Science, and. 5. 5Radiology and Nuclear Medicine, and. 6. 6Pathology, St. Olavs University Hospital, Trondheim. 7. 7Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim. 8. 8Department of Health Research, SINTEF Technology and Society, Trondheim, Norway. 9. 9Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg; and. 10. 10Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.
Abstract
OBJECTIVE: Extent of resection (EOR) and residual tumor volume are linked to prognosis in low-grade glioma (LGG) and there are various methods for facilitating safe maximal resection in such patients. In this prospective study the authors assess radiological and clinical results in consecutive patients with LGG treated with 3D ultrasound (US)-guided resection under general anesthesia. METHODS: Consecutive LGGs undergoing primary surgery guided with 3D US between 2008 and 2015 were included. All LGGs were classified according to the WHO 2016 classification system. Pre- and postoperative volumetric assessments were performed, and volumetric results were linked to overall and malignant-free survival. Pre- and postoperative health-related quality of life (HRQoL) was evaluated. RESULTS: Forty-seven consecutive patients were included. Twenty LGGs (43%) were isocitrate dehydrogenase (IDH)-mutated, 7 (14%) were IDH wild-type, 19 (40%) had both IDH mutation and 1p/19q codeletion, and 1 had IDH mutation and inconclusive 1p/19q status. Median resection grade was 93.4%, with gross-total resection achieved in 14 patients (30%). An additional 24 patients (51%) had small tumor remnants < 10 ml. A more conspicuous tumor border (p = 0.02) and lower University of California San Francisco prognostic score (p = 0.01) were associated with less remnant tumor tissue, and overall survival was significantly better with remnants < 10 ml (p = 0.03). HRQoL was maintained or improved in 86% of patients at 1 month. In both cases with severe permanent deficits, relevant ischemia was present on diffusion-weighted postoperative MRI. CONCLUSIONS: Three-dimensional US-guided LGG resections under general anesthesia are safe and HRQoL is preserved in most patients. Effectiveness in terms of EOR appears to be consistent with published studies using other advanced neurosurgical tools. Avoiding intraoperative vascular injury is a key factor for achieving good functional outcome.
OBJECTIVE: Extent of resection (EOR) and residual tumor volume are linked to prognosis in low-grade glioma (LGG) and there are various methods for facilitating safe maximal resection in such patients. In this prospective study the authors assess radiological and clinical results in consecutive patients with LGG treated with 3D ultrasound (US)-guided resection under general anesthesia. METHODS: Consecutive LGGs undergoing primary surgery guided with 3D US between 2008 and 2015 were included. All LGGs were classified according to the WHO 2016 classification system. Pre- and postoperative volumetric assessments were performed, and volumetric results were linked to overall and malignant-free survival. Pre- and postoperative health-related quality of life (HRQoL) was evaluated. RESULTS: Forty-seven consecutive patients were included. Twenty LGGs (43%) were isocitrate dehydrogenase (IDH)-mutated, 7 (14%) were IDH wild-type, 19 (40%) had both IDH mutation and 1p/19q codeletion, and 1 had IDH mutation and inconclusive 1p/19q status. Median resection grade was 93.4%, with gross-total resection achieved in 14 patients (30%). An additional 24 patients (51%) had small tumor remnants < 10 ml. A more conspicuous tumor border (p = 0.02) and lower University of California San Francisco prognostic score (p = 0.01) were associated with less remnant tumor tissue, and overall survival was significantly better with remnants < 10 ml (p = 0.03). HRQoL was maintained or improved in 86% of patients at 1 month. In both cases with severe permanent deficits, relevant ischemia was present on diffusion-weighted postoperative MRI. CONCLUSIONS: Three-dimensional US-guided LGG resections under general anesthesia are safe and HRQoL is preserved in most patients. Effectiveness in terms of EOR appears to be consistent with published studies using other advanced neurosurgical tools. Avoiding intraoperative vascular injury is a key factor for achieving good functional outcome.
Entities:
Keywords:
DWI = diffusion-weighted imaging; EOR = extent of resection; FISH = fluorescence in situ hybridization; GTR = gross-total resection; HRQoL = health-related quality of life; IDH = isocitrate dehydrogenase; IQR = interquartile range; KPS = Karnofsky Performance Scale; LGG = low-grade glioma; MCID = minimal clinically important difference; MFS = malignant-free survival; MPRAGE = magnetization-prepared rapid gradient echo; OR = odds ratio; OS = overall survival; RANO = Response Assessment in Neuro-Oncology; UCSF = University of California San Francisco; US = ultrasound; extent of resection; iMRI = intraoperative MRI; low-grade glioma; neurooncology; oncology; segmentation; surgical technique; ultrasound
Authors: Tamara Ius; Edoardo Mazzucchi; Barbara Tomasino; Giada Pauletto; Giovanni Sabatino; Giuseppe Maria Della Pepa; Giuseppe La Rocca; Claudio Battistella; Alessandro Olivi; Miran Skrap Journal: Sci Rep Date: 2021-05-11 Impact factor: 4.379