Artikel
Intraoperative resection control tools in intra-axial high-grade lesions
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Autoren
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Marian Christoph Neidert
- Neurochirurgische Klinik, Universitätsspital Zürich, Zürich, Switzerland
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Isabel Charlotte Hostettler
- Neurochirurgische Klinik, Universitätsspital Zürich, Zürich, Switzerland
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Jan-Karl Burkhardt
- Neurochirurgische Klinik, Universitätsspital Zürich, Zürich, Switzerland
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Luca Regli
- Neurochirurgische Klinik, Universitätsspital Zürich, Zürich, Switzerland
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Niklaus Krayenbühl
- Neurochirurgische Klinik, Universitätsspital Zürich, Zürich, Switzerland
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Oliver Bozinov
- Neurochirurgische Klinik, Universitätsspital Zürich, Zürich, Switzerland
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Christoph M. Woernle
- Neurochirurgische Klinik, Universitätsspital Zürich, Zürich, Switzerland
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: To analyze the impact of intraoperative resection control modalities on tumor recurrence at the 3-month postoperative magnetic resonance imaging (MRI) following intended microsurgical complete resections of high-grade intracerebral lesions.
Method: We retrospectively analyzed the data of 191 patients (88 females, 103 men, mean age 60 years) with intra-axial high-grade lesions. Patients included 77 subjects with primary intracerebral tumors and 114 cases with metastases, treated at our institution between 2010 and 2012. Neuronavigation was used in all cases. Intraoperative resection control modalities consisted of intraoperative ultrasound (ioUS, 114 cases), intraoperative MRI (low-field ioMRI, 35 cases), 5-aminolevulinic acid (5-ALA, 23 glioma cases) and a control group of 41 patients without intraoperative resection control (only neuronavigation). In a small subgroup of cases (25) more than one modality was used. The point of our study was to determine the rate of tumor recurrence at the 3-months postoperative MRI (institutional follow-up protocol) related to intraoperative resection control modalities. Statistical analysis was performed using SPSS 20 (IBM, Chicago, IL, USA). Pearsons's Chi-Squared test was used for two-sided hypothesis testing – a p value <0.05 was considered significant.
Results: Looking at all patients as well as analyzing the two major subgroups (primary brain tumors vs. metastases), neither ioMRI nor 5-ALA showed significant benefits regarding tumor recurrence at the 3-months postoperative MRI. In contrast, ioUS was associated with a significant decrease of tumor recurrence in the primary intracerebral tumors group (p=0.047), but not in the metastases group (p=0.72).
Conclusions: Intraoperative US is associated with decreased tumor recurrence following high-grade glioma surgery, but not after metastasis resection. Further studies should compare intraoperative resection control tools in a prospective fashion with a focus on clinical parameters, such as overall and progression-free survival as well as quality of life.
