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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Outcome after surgical treatment of recurrent glioblastoma multiforme with intraoperative high-field magnetic resonance imaging

Meeting Abstract

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  • M. Hlavac - Neurochirurgische Klinik der Universität Ulm am BKH-Günzburg
  • R. König - Neurochirurgische Klinik der Universität Ulm am BKH-Günzburg
  • T. Schmidt - Neurochirurgische Klinik der Universität Ulm am BKH-Günzburg
  • K. Seitz - Neurochirurgische Klinik der Universität Ulm am BKH-Günzburg
  • J. Engelke - Neurochirurgische Klinik der Universität Ulm am BKH-Günzburg
  • C.R. Wirtz - Neurochirurgische Klinik der Universität Ulm am BKH-Günzburg

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. DocMO.04.03

doi: 10.3205/11dgnc011, urn:nbn:de:0183-11dgnc0110

Published: April 28, 2011

© 2011 Hlavac et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Despite multimodal treatment recurrent tumor growth in glioblastoma multiforme occurs regularly. Repeated surgery seems often the best treatment but despite additional therapy, the prognosis remains poor. The repeated surgery is more demanding, because brain tissue properties are altered through the adjuvant treatment and distinction between brain tissue and tumor is even more difficult. Regularly occurring cystic tumor components cause a pronounced brain shift limiting the reliability of neuronavigation. Since introduction of the intraoperative magnetic resonance imaging (MRI) at our institution, several recurrent glioblastoma tumors have been treated using this technique.

Methods: Retrospective analysis of the outcome of repeated surgery in 15 consecutive patients with recurrent glioblastoma multiforme treated between October 2008 and September 2010 at our institution. Navigated microsurgical resection and intraoperative high-field MRI scanning were followed by continued surgery in the presence of resectable tumor remnant. The extent of resection was evaluated on postoperative MRI conducted within 72 hours after surgery. Following surgery the patients received customized systemic therapy and repeated radiation if deemed possible.

Results: The median age was 61 years (41 to 79), tumor volume 18.8 cm3 (4.8 to 45.3cm3). In three patients (20%) the intraoperative MRI showed gross total resection (GTR) of enhancing tumor. Continued surgery lead to GTR in 12 (80%) in the postoperative MRI scanning. We observed no significant worsening of the neurological symptoms. The median survival was 15.1 (8.3 to 56.5) months since diagnosis and 7.1 (3.0 to 19.6) months since repeated surgery in our patient population. Seven patients were still alive at the time of analysis.

Conclusions: Surgery in recurrent glioblastoma is in spite of often relatively small tumors detected on sequential scanning a difficult task. Given the poor prognosis surgical morbidity must be kept low. The tissue properties are significantly altered after adjuvant treatment and neuronavigation is often because large brain-shift unreliable. Intraoperative MRI can help to increase the proportion of GTR while helping to preserve function in selected patients.