FLAIRectomy in Supramarginal Resection of Glioblastoma Correlates With Clinical Outcome and Survival Analysis: A Prospective, Single Institution, Case Series

被引：57

作者：

Certo, Francesco ^{[1
,2
]}

Altieri, Roberto ^{[1
]}

Maione, Massimiliano ^{[1
]}

Schonauer, Claudio ^{[3
]}

Sortino, Giuseppe ^{[4
]}

Fiumano, Giuseppa ^{[3
]}

Tirro, Elena ^{[5
]}

Massimino, Michele ^{[5
]}

Broggi, Giuseppe ^{[6
]}

Vigneri, Paolo ^{[5
]}

Magro, Gaetano ^{[6
]}

Visocchi, Massimiliano ^{[7
]}

Barbagallo, Giuseppe M., V ^{[1
,2
]}

机构：

[1] Univ Catania, Policlin G Rodolico San Marco Univ Hosp, Neurol Surg, Dept Med & Surg Sci & Adv Technol GF Ingrassia, Catania, Italy

[2] Univ Catania, Interdisciplinary Res Ctr Brain Tumors Diag & Tre, Catania, Italy

[3] Santa Maria Grazie Hosp ASLNa2Nord, Dept Neurol Surg, Via Domitiana, Naples, Italy

[4] Univ Hosp Policlin Vittorio Emanuele, Dept Radiodiagnost & Oncol Radiotherapy, Via S Sofia, Catania, Italy

[5] Univ Hosp Policlin Vittorio Emanuele, Ctr Expt Oncol & Hematol, Dept Clin & Expt Med, Via S Sofia, Catania, Italy

[6] Univ Catania, Policlin G Rodol San Marco Univ Hosp, Anat Pathol, Dept Med & Surg Sci & Adv Technol GF Ingrassia, Catania, Italy

[7] Catholic Univ, Inst Neurosurg, Via Pineta Sacchetn, Rome, Italy

来源：

OPERATIVE NEUROSURGERY | 2021年 / 20卷 / 02期

关键词：

5-ALA; Extent of resection; FLAIR; FLAIRectomy; Glioblastoma; i-CT; Survival; Neuronavigation; FLUORESCENCE-GUIDED SURGERY; GAMMA-KNIFE RADIOSURGERY; 5-AMINOLEVULINIC ACID; PHASE-III; RADIOTHERAPY; HYPERINTENSITY; TEMOZOLOMIDE; RECOVERY; GLIOMAS; IMPACT;

D O I：

10.1093/ons/opaa293

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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 T1MR 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 (R-2 = 0.46), and OS (R-2 = 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.

引用

页码：151 / 163

页数：13

共 36 条

[1] Intraoperative computed tomography, navigated ultrasound, 5-amino-levulinic acid fluorescence and neuromonitoring in brain tumor surgery: overtreatment or useful tool combination? [J].