gms | German Medical Science

Glioblastoma is known as an infiltrating, highly malignant tumour not curable with neurosurgical procedures. However, different studies have shown that the extent of resection might have an influence on the further course of the disease. We investigated the impact of neuronavigation as an adjunct for surgery in patients with glioblastoma.

78 patients harbouring an intracranial glioblastoma and being treated surgically in our institution between 1997 and 2003 were eligible for this retrospective study. Patients with pre- or postoperative severe neurological deficits or other factors limiting the use of adjuvant therapy were not included in this study. In 22 patients (15 men, 7 women, group A) tumours were resected with neuronavigational guidance, whereas 56 patients (38 men, 18 women, group B) were treated using conventional microsurgical methods. Mean age was 53 years (group A) and 57.8 years (group B), respectively. Genders were distributed similarly in both groups. Karnofsky score was over 60% in all patients of both groups. Radiation therapy followed the neurosurgical procedure in all cases. Chemotherapy was initiated in only a part of the patients, with no significant differences between the groups (68% vs. 57%, p=0.37, chi-square test). Groups were further subdivided according to the extent of resection as judged intraoperatively by the surgeon (gross total, subtotal, biopsy). Progression free survival (PFS) was analyzed for both groups and their subdivisions. Relapse was defined as new enhancement in follow-up MRI or clinically based on new neurological disturbances.

Overall PFS in group A was 11.3 months compared to 8.0 months in group B. Concerning the groups with gross total tumour removal, PFS was 12.8 months (group A) and 9.6 months (group B), respectively. Highest PFS was achieved in the patients with navigation-assisted resection, followed by radiation and chemotherapy (18.4 months vs. 10.5 months for the respective subdivision of group B). Statistical analysis, however, failed to demonstrate significant differences (p=0.061, ANOVA).

Using neuronavigational assistance appears to improve the extent of resection in surgery for glioblastoma which in turn leads to an increase in progression-free survival. Further studies are warranted to demonstrate significant advantages for the patients.