Artikel
Impact of neuronavigation and image-guided extensive resection for adult supratentorial malignant astrocytomas
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Autoren
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M. Kurimoto
- Department of Neurosurgery, Toyama University Hospital, Toyama, Japan
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S. Nagai
- Department of Neurosurgery, Toyama University Hospital, Toyama, Japan
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H. Kamiyama
- Department of Neurosurgery, Toyama University Hospital, Toyama, Japan
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N. Hayashi
- Department of Neurosurgery, Toyama University Hospital, Toyama, Japan
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S. Endo
- Department of Neurosurgery, Toyama University Hospital, Toyama, Japan
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Neuronavigation has become an effective therapeutic modality and is used routinely for intra-axial tumor removal. This retrospective study was conducted to evaluate the clinical impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas.
Methods: Between 1990 and 2004, 92 adult patients with malignant astrocytomas confirmed by pathology, underwent craniotomy and removal of the tumors at the Toyama University Hospital. Of these 92 patients, 55 were treated using neuronavigation with conventional microneurosurgery and the other 37 were treated with conventional microneurosurgery alone. Postoperative early MRI with contrast enhancement was done, and gross total resection was defined as the complete absence of residual tumor. Survival time was analysed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox proportional hazards model.
Results: In univariate analysis, age (<65), grade 3, preoperative KPS (≥80), use of neuronavigation and gross total resection were significantly associated with longer survival. However, when the data were submitted to multivariate analysis, grade 3, preoperative KPS (≥80), and gross total resection were independent prognostic factors. The median survival periods of patients receiving gross total resection (vs. partial resection) and neuronavigation (vs. no neuronavigation) were 16 (vs. 9) months and 16 (vs. 10) months, respectively. The percentage of a gross total resection was significantly higher in the neuronavigation group compared to in the no-navigation group (65.5% vs. 43.2%, p<0.05). Neurological deterioration occurred in 5 of 55 (9.1%) and in 6 of 37 (16.2%) patients after surgery with neuronavigation and surgery without neuronavigation, respectively, although this difference was not statistically significant.
Conclusions: Our results showed that neuronavigation increases the radicality of the resection of malignant astrocytomas and is objectively useful for improving survival time.
