Giovanni Raffa1, Antonino Scibilia2, Alfredo Conti3, Salvatore Massimiliano Cardali3, Vincenzo Rizzo4, Carmen Terranova4, Maria Catena Quattropani5, Giuseppina Marzano5, Giuseppe Ricciardo3, Sergio Lucio Vinci6, Antonino Germanò3. 1. Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy. Electronic address: giovanni.raffa@unime.it. 2. Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy; Division of Neurosurgery, University of Strasbourg, Strasbourg, France. 3. Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy. 4. Division of Neurology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. 5. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. 6. Division of Neuroradiology, BIOMORF Department, University of Messina, Messina, Italy.
Abstract
BACKGROUND: Fluorescein-guided surgery of high-grade gliomas (HGGs) increases the extent of tumor resection but its efficacy has been questioned, especially for tumors located close to functional networks. In these cases, navigated transcranial magnetic stimulation (nTMS) may be used to plan and guide a safe resection. The aim of this study was to assess the impact of these techniques combined with intraoperative neurophysiologic mapping (IONM) to achieve the maximal safe resection of tumors located in the motor area. METHODS: We collected data of patients operated using a multimodal combination of sodium fluorescein-guided resection, nTMS motor planning, and IONM for HGGs in the motor area. The nTMS planning accuracy, extent of resection, and postoperative motor and functional status were compared with a matched control group of patients with HGG operated on only by IONM-guided resection. RESULTS: Forty-one patients treated by multimodal approach (group A) and 41 controls (group B) were included. The nTMS-based planning reliably identified the tumor/motor pathway spatial relationship (accuracy, 92.68%). We obtained in group A versus controls a higher gross total resection rate (73.17% vs. 51.22%; P = 0.04), and a reduction of cases with new permanent motor deficits (9.75% vs. 29.27%; P = 0.04) or Karnofsky Performance Status worsening (12.19% vs. 31.71%; P = 0.03). CONCLUSIONS: This study supports the role of the combination of sodium fluorescein-guided resection and nTMS-based planning for surgery of HGGs close to the motor pathway. This multimodal approach in combination with IONM may lead to customized preoperative planning, increased extent of resection, and improved functional outcome, compared with standard IONM-guided surgery.
BACKGROUND:Fluorescein-guided surgery of high-grade gliomas (HGGs) increases the extent of tumor resection but its efficacy has been questioned, especially for tumors located close to functional networks. In these cases, navigated transcranial magnetic stimulation (nTMS) may be used to plan and guide a safe resection. The aim of this study was to assess the impact of these techniques combined with intraoperative neurophysiologic mapping (IONM) to achieve the maximal safe resection of tumors located in the motor area. METHODS: We collected data of patients operated using a multimodal combination of sodium fluorescein-guided resection, nTMS motor planning, and IONM for HGGs in the motor area. The nTMS planning accuracy, extent of resection, and postoperative motor and functional status were compared with a matched control group of patients with HGG operated on only by IONM-guided resection. RESULTS: Forty-one patients treated by multimodal approach (group A) and 41 controls (group B) were included. The nTMS-based planning reliably identified the tumor/motor pathway spatial relationship (accuracy, 92.68%). We obtained in group A versus controls a higher gross total resection rate (73.17% vs. 51.22%; P = 0.04), and a reduction of cases with new permanent motor deficits (9.75% vs. 29.27%; P = 0.04) or Karnofsky Performance Status worsening (12.19% vs. 31.71%; P = 0.03). CONCLUSIONS: This study supports the role of the combination of sodium fluorescein-guided resection and nTMS-based planning for surgery of HGGs close to the motor pathway. This multimodal approach in combination with IONM may lead to customized preoperative planning, increased extent of resection, and improved functional outcome, compared with standard IONM-guided surgery.
Authors: Carolin Weiss Lucas; Andrea Maria Faymonville; Ricardo Loução; Catharina Schroeter; Charlotte Nettekoven; Ana-Maria Oros-Peusquens; Karl Josef Langen; N Jon Shah; Gabriele Stoffels; Volker Neuschmelting; Tobias Blau; Hannah Neuschmelting; Martin Hellmich; Martin Kocher; Christian Grefkes; Roland Goldbrunner Journal: Front Oncol Date: 2022-05-27 Impact factor: 5.738