gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

Extent of resection in high-grade gliomas in a single University Medical Centre

Meeting Abstract

  • C. Doenitz - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • E. Bründl - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • A. Haj - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • A. Herbst - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • M. Proescholdt - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • A. Brawanski - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.03.05

DOI: 10.3205/11dgnc118, URN: urn:nbn:de:0183-11dgnc1186

Veröffentlicht: 28. April 2011

© 2011 Doenitz et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: In high-grade gliomas the extent of resection correlates with the progression-free and overall survival, referring to recent studies. Thus largest possible resection of contrast enhancement becomes a key part of advanced glioma surgery. Historically, complete resections of contrast-enhancing tumor had only been reported in approximately 20%. With the progress of surgical methods and techniques nowadays we were interested in the extent of resection in high-grade gliomas using up-to-date methods in our own centre over the last three years.

Methods: All patients with contrast enhancing high-grade gliomas WHO°III or °IV who were operated for the first time at our centre in between January 2008 and November 2010 were included. Patients with an intended partial resection due to involvement of insula, basal ganglia or corpus callosum were excluded. We retrospectively analyzed MRI scans, which were obtained at our centre preoperatively and within 72 hours after surgery. 44 patients (34–69 ys, average 62 ys) could be included (36 glioblastomas, 5 anaplastic gliomas, 3 gliosarcomas). Volumetry of pre- and postoperative contrast enhancement was done on 3D-MPR scans using a segmentation software (iPlan – Brainlab). Thus also complex configuration of residual tumors could be segmented voxel by voxel.

Results: A median of 96,4% of resection of contrast enhancement on early postoperative MRI scans could be reached by using ultrasound, navigation, preoperative fMRI, DTI and awake procedures with intraoperative monitoring if necessary. Gross tumor resection rate (>90% removal) was 93,2%, 34,1% had complete resections and a minimum of 84,1% tumor removal could always be achieved. The median residual volumes of tumors were 1,5 cm3. Ultrasound was used in 61%, navigation in 66%, fRMI and DTI in 18% and awake craniotomy with brain mapping was performed in 5 patients (11%).

Conclusions: With recent studies showing benefit from largest possible resection in high-grade gliomas, extent of resection becomes important. Availability of tools like navigation, ultrasound, preoperative fMRI, DTI, PET and awake procedures with intraoperative brain mapping can help to maximize extent of resection without increasing postoperative deficits. In this study we could state comparable results at our own centre regarding the ALA-study (complete resection 34 vs. 36% control arm, residual tumor 1,5 vs. 1,5 cm3 both arms), despite our patients were not that highly preselected. This should be a good basis for further improvement.