Neurosurgery. 2012 Aug 14. [Epub ahead of print]
Gross Total Resection Rates in Contemporary Glioblastoma Surgery: Results of an Institutional Protocol Combining 5-ALA Intraoperative Fluorescence Imaging and Brain Mapping.
Schucht P, Beck J, Abu-Isa J, Andereggen L, Murek M, Seidel K, Stieglitz L, Raabe A.
1Department of Neurosurgery, Bern University Hospital, Bern, Switzerland 2Department of Neuroradiology, Bern University Hospital, Bern, Switzerland.
Complete resection of contrast-enhancing tumor has been recognized as an important prognostic factor in patients with glioblastoma and is a primary goal of surgery. Various intraoperative technologies have recently been introduced to improve glioma surgery.
We evaluated the impact of using 5-aminolevulinic acid (5-ALA) and intraoperative mapping and monitoring on the rate of complete resection of enhancing tumor (CRET), gross total resection (GTR), and new neurological deficits as part of an institutional protocol.
103 consecutive patients underwent resection of glioblastoma from August 2008 to November 2010. Eligibility for complete resection of enhancing tumor was based on the initial MRI assessed by two reviewers. The primary endpoint was the number of patients with CRET and GTR. Secondary endpoints were volume of residual contrast-enhancing tissue and new postoperative neurological deficits.
Fifty-three patients were eligible for GTR/CRET (n=43 newly diagnosed glioblastoma; n=10 recurrent) and 13 additional patients received surgery for GTR/CRET-ineligible glioblastoma. GTR was achieved in 96% of patients (n=51, no residual enhancement >0.175 cc). CRET was achieved in 89% (n=47, no residual enhancement). Postoperatively, two patients experienced worsening of preoperative hemianopia, one had a new mild hemiparesis and another patient sustained sensory deficits.
Using 5-ALA imaging and intraoperative mapping/monitoring together leads to a high rate of CRET and an increased rate of GTR compared to the literature without increasing the rate of permanent morbidity. The combination of safety and resection-enhancing intraoperative technologies were likely to be the major drivers for this high rate of CRET/GTR.