Francesco Certo1,2, Roberto Altieri1, Massimiliano Maione1, Claudio Schonauer3, Giuseppe Sortino4, Giuseppa Fiumanò3, Elena Tirrò5, Michele Massimino5, Giuseppe Broggi6, Paolo Vigneri5, Gaetano Magro6, Massimiliano Visocchi7, Giuseppe M V Barbagallo1,2. 1. Department of Medical and Surgical Sciences and Advanced Technologies (G.F. Ingrassia), Neurological Surgery, Policlinico ``G. Rodolico - San Marco'' University Hospital, University of Catania, Italy. 2. Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Via S. Sofia, Catania, Italy. 3. Department of Neurological Surgery, Santa Maria delle Grazie Hospital ASLNa2Nord, Via Domitiana, Naples, Italy. 4. Department of Radiodiagnostic and Oncological Radiotherapy, University Hospital Policlinico-Vittorio Emanuele, Via S. Sofia, Catania, Italy. 5. Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University Hospital Policlinico-Vittorio Emanuele, Via S. Sofia, Catania, Italy. 6. Department of Medical and Surgical Sciences and Advanced Technologies (G.F. Ingrassia), Anatomic Pathology, Policlinico ``G. Rodolico - San Marco'' University Hospital, University of Catania, Italy. 7. Institute of Neurosurgery, Catholic University, Via della Pineta Sacchetti, Rome, Italy.
Abstract
BACKGROUND: Extent of tumor resection (EOTR) in glioblastoma surgery plays an important role in improving survival. OBJECTIVE: To analyze the efficacy, safety and reliability of fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) images used to guide glioblastoma resection (FLAIRectomy) and to volumetrically measure postoperative EOTR, which was correlated with clinical outcome and survival. METHODS: A total of 68 glioblastoma patients (29 males, mean age 65.8) were prospectively enrolled. Hyperintense areas on FLAIR images, surrounding gadolinium-enhancing tissue on T1-weighted MR images, were screened for signal changes suggesting tumor infiltration and evaluated for supramaximal resection. The surgical protocol included 5-aminolevulinic acid (5-ALA) fluorescence, neuromonitoring, and intraoperative imaging tools. 5-ALA fluorescence intensity was analyzed and matched with the different sites on navigated MR, both on postcontrast T1-weighted and FLAIR images. Volumetric evaluation of EOTR on T1-weighted and FLAIR sequences was compared. RESULTS: FLAIR MR volumetric evaluation documented larger tumor volume than that assessed on contrast-enhancing T1 MR (72.6 vs 54.9 cc); residual tumor was seen in 43 patients; postcontrast T1 MR volumetric analysis showed complete resection in 64 cases. O6-methylguanine-DNA methyltransferase promoter was methylated in 8/68 (11.7%) cases; wild type Isocytrate Dehydrogenase-1 (IDH-1) was found in 66/68 patients. Progression free survival and overall survival (PFS and OS) were 17.43 and 25.11 mo, respectively. Multiple regression analysis showed a significant correlation between EOTR based on FLAIR, PFS (R2 = 0.46), and OS (R2 = 0.68). CONCLUSION: EOTR based on FLAIR and 5-ALA fluorescence is feasible. Safety of resection relies on the use of neuromonitoring and intraoperative multimodal imaging tools. FLAIR-based EOTR appears to be a stronger survival predictor compared to gadolinium-enhancing, T1-based resection.
BACKGROUND: Extent of tumor resection (EOTR) in glioblastoma surgery plays an important role in improving survival. OBJECTIVE: To analyze the efficacy, safety and reliability of fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) images used to guide glioblastoma resection (FLAIRectomy) and to volumetrically measure postoperative EOTR, which was correlated with clinical outcome and survival. METHODS: A total of 68 glioblastomapatients (29 males, mean age 65.8) were prospectively enrolled. Hyperintense areas on FLAIR images, surrounding gadolinium-enhancing tissue on T1-weighted MR images, were screened for signal changes suggesting tumor infiltration and evaluated for supramaximal resection. The surgical protocol included 5-aminolevulinic acid (5-ALA) fluorescence, neuromonitoring, and intraoperative imaging tools. 5-ALA fluorescence intensity was analyzed and matched with the different sites on navigated MR, both on postcontrast T1-weighted and FLAIR images. Volumetric evaluation of EOTR on T1-weighted and FLAIR sequences was compared. RESULTS: FLAIR MR volumetric evaluation documented larger tumor volume than that assessed on contrast-enhancing T1 MR (72.6 vs 54.9 cc); residual tumor was seen in 43 patients; postcontrast T1 MR volumetric analysis showed complete resection in 64 cases. O6-methylguanine-DNA methyltransferase promoter was methylated in 8/68 (11.7%) cases; wild type Isocytrate Dehydrogenase-1 (IDH-1) was found in 66/68 patients. Progression free survival and overall survival (PFS and OS) were 17.43 and 25.11 mo, respectively. Multiple regression analysis showed a significant correlation between EOTR based on FLAIR, PFS (R2 = 0.46), and OS (R2 = 0.68). CONCLUSION: EOTR based on FLAIR and 5-ALA fluorescence is feasible. Safety of resection relies on the use of neuromonitoring and intraoperative multimodal imaging tools. FLAIR-based EOTR appears to be a stronger survival predictor compared to gadolinium-enhancing, T1-based resection.
Authors: Alexander A Aabedi; Jacob S Young; Yalan Zhang; Simon Ammanuel; Ramin A Morshed; Cecilia Dalle Ore; Desmond Brown; Joanna J Phillips; Nancy Ann Oberheim Bush; Jennie W Taylor; Nicholas Butowski; Jennifer Clarke; Susan M Chang; Manish Aghi; Annette M Molinaro; Mitchel S Berger; Shawn L Hervey-Jumper Journal: Neurosurgery Date: 2022-01-01 Impact factor: 5.315
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: Giuseppe Broggi; Eliana Piombino; Roberto Altieri; Chiara Romano; Francesco Certo; Giuseppe Maria Vincenzo Barbagallo; Paolo Vigneri; Dario Condorelli; Lorenzo Colarossi; Cristina Colarossi; Gaetano Magro; Elena Tirrò Journal: Front Neurol Date: 2022-02-09 Impact factor: 4.003
Authors: Cassandra P Griffin; Christine L Paul; Kimberley L Alexander; Marjorie M Walker; Hubert Hondermarck; James Lynam Journal: Neurooncol Adv Date: 2021-11-18