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Improvement of functional outcome after radical surgery in glioblastoma patients: the efficacy of a navigation-guided fence-post procedure and neurophysiological monitoring

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Summary

This retrospective study investigated the functional outcomes of patient with glioblastoma receiving radical surgery before and after the adoption of the navigation-guided fence-post (NGFP) procedure and neurophysiological monitoring. We investigated 42 glioblastoma patients receiving radical surgery in our institute between 1980 and 2005. Of the 42 patients, 18 patients from 1980 to 1996 (1st term) underwent radical surgery without navigation system guidance, NGFP, or neurophysiological monitoring; 11 patients from 1997 to 2002 (2nd term) underwent surgery with simple navigation system guidance but without NGFP procedure or neurophysiological monitoring, and 13 patients from 2003 to 2005 (3rd term) underwent surgery with the NGFP procedure and neurophysiological monitoring as appropriate. There were no significance differences between any of the three term groups in age, gender, preoperative KPS score, or ‘surgical staging for glioma’ according to the difficulty of surgery. The rates of 95% or greater volume reduction in each term were 38.9%, 54.5% and 76.9%. The rates of morbidity were 38.9%, 18.1% and 0%. The change in KPS scores (delta KPS) before and after the perioperative period in each term were −16.1 ± 6.6SEM, −9.0 ± 5.8SEM and +8.5 ± 3.7SEM, respectively. The delta KPS in the 3rd term was significantly better than those of 1st and 2nd terms (P < 0.01, Kruskal–Wallis rank test). The rate of patients who were discharged to home and who resumed daily useful life without assistance was 38.9%, 63.6% and 84.6% in each term, respectively. The mean survival times in each term were 9.9, 14.0 and 16.8 months. The introduction of the NGFP procedure and neurophysiological monitoring in glioblastoma radical surgery improved the functional outcome of patients.

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References

  1. Vourinen V, Hinkka S, Farkkila M, Jaaskelainen, Dubulking or biopsy of malignant glioma in elderly people – randomized study Acta Neurochir 145: 5–10, 2003

    Article  Google Scholar 

  2. Metcalfe SE, Grant R: Biospy versus resection for malignant glioma. Cochrane Database Syst Rev 3: CD002034, 2001

  3. Eisner W, Burtscher J, Bale R, Sweeney R, Koppelstatter F, Golaszewski S, Kolbitsch C, Twerdy K, Use of neuronavigation and electrophysiology in surgery of subcortically located lesions in the sensorimotor strip J Neurol Neurosurg Psychiatry 72: 378–381, 2002

    Article  PubMed  CAS  Google Scholar 

  4. Dorward NL, Alberti O, Velani B, Gerritsen FA, Harkness WF, Kitchen ND, Thomas DG, Postimaging brain distortion: magnitude, correlates, and impact on neuronavigation J Neurosurg 88: 656–662, 1998

    PubMed  CAS  Google Scholar 

  5. Gumprecht HK, Widenka DC, Lumenta CB, BrainLab VectorVision neuronavigation system: technology and clinical experiences in 131 cases Neurosurgery 44: 97–105, 1999

    Article  PubMed  CAS  Google Scholar 

  6. Bewrger MS: Lesions in functional (“eloquent”) cortex and subcortical white matter Clin Neurosurg 41: 444–463, 1994

    PubMed  Google Scholar 

  7. Duffau H, Capella L, Sichez N, Intraoperative mapping of the subcortical language pathways using direct stimulations. An anatomo-functional study Brain 125: 199–214, 2002

    Article  PubMed  Google Scholar 

  8. Keles GE, Lundin DA, Lamborn KR, Chang EF, Ojemann G, Berger MS, Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients J Neurosurg 100: 369–375, 2004

    PubMed  Google Scholar 

  9. Nimsky C, Ganslandt O, Kober H, Moller M, Ulmer S, Tomandl B, Fahlbusch R, Integration of functional magnetic resonance imaging supported by magnetoencepahalography in functional neuronavigation Neurosurgery 44: 1249–1256, 1999

    Article  PubMed  Google Scholar 

  10. Mori S, Van Zijl PC, Fiber tracking: principles and strategies – a technical review NMR Biomed 15: 468–480, 2002

    Article  PubMed  Google Scholar 

  11. Berger MS, Ojemann GA, Lettich E, Neurophysiological monitoring during astrocytoma surgery Neurosurg Clin N Am 1: 65–80, 1990

    PubMed  CAS  Google Scholar 

  12. Katayama Y, Tsubokawa T, Maejima S, Hirayama T, Yamamoto T, Corticospinal direct response in human: identification of the motor cortex during intracranial surgery under general anesthesia J Neurol Neurosurg Psychiat 51: 50–59, 1988

    PubMed  CAS  Google Scholar 

  13. Yamamoto T, Katayama Y, Nagaoka T, Kobayashi K, Fukaya C, Intraoperative monitoring of the corticospinal motor evoked potential (D-wave): clinical index for postoperative motor function and functional recovery Neurol Med Chir(Tokyo) 44: 170–182, 2004

    Article  Google Scholar 

  14. Berger MS, Kincaid J, Ojemann GA, Lettich E, Brain mapping techniques to maximize resection, safety, and seizure control in children with brain tumors Neurosurgery 25: 786–792, 1989

    Article  PubMed  CAS  Google Scholar 

  15. Karnofsky DA, Burchmal JH, 1949 The clinical evaluation of chemotherapeutic agents in cancer, in: MacLeod CM, (ed): Evaluation of Chemotherapeutic Agents New York: Columbia University Press, pp 191–205

    Google Scholar 

  16. Kayama T, Sonoda Y, Sato S, Fujimaki T, Shibui S, Nomura K, A proposed atging system for glioma surgery Jpn J Neurosurg(Tokyo) 13: 448–453, 2004

    Google Scholar 

  17. Walker MD, Alexander E Jr, Hunt WE, MacCarty CS, Mahaley MS Jr, Mealey J Jr, Norrell HA, Qwens G, Ransohoff J, Wilson CB, Gehan EA, Strike TA, Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas: a cooperative clinical trial J Neurosurg 49: 333–343, 1978

    Article  PubMed  CAS  Google Scholar 

  18. Walker MD, Green SB, Byar DP, Alexander E Jr, Batzdorf U, Brooks WH, Hunt WE, MacCarty CS, Mahaley MS Jr, Mealey J Jr, Owens G, Ransohoff J II, Robertson JT, Shapiro WR, Smith KR Jr, Wilson CB, Strike TA, Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery N Engl J Med 303: 1323–1329, 1980

    Article  PubMed  CAS  Google Scholar 

  19. Kristiansen K, Hagen S, Kollevold T, Torvik A, Holme I, Nesbakken R, Hatlevoll R, Lindgren M, Brun A, Lindgren S, Notter G, Andersen AP, Elgen K, Combined modality therapy of operated astrocytomas grade III and IV: confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma Study Group Cancer 47: 649–652, 1981

    Article  PubMed  CAS  Google Scholar 

  20. Sawaya R, Hammoud M, Schoppa D, Hess KR, Wu SZ, Shi WM, Wildrick DM, Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors Neurosurgery 42: 1044–1055, 1998

    Article  PubMed  CAS  Google Scholar 

  21. Taylor M, Bernstein M, Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentrial intraaxial tumors: a prospective trial of 200 cases J Neurosurg 90: 35–41, 1999

    PubMed  CAS  Google Scholar 

  22. Brell M, Ibanez J, Caral L, Ferrer E, Factors influencing surgical complications of intra-axial brain tumours Acta Neurochir (Wien) 142: 739–750, 2000

    Article  CAS  Google Scholar 

  23. Chang SM, Parney IF, McDermott M, Braker FG, Schmidt MH, Huang W, Laws ER Jr, Lillehei KO, Bernstein M, Brem H, Sloan AE, Berger M, Perioerative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project J Neurosurg 98: 1175–1181, 2003

    PubMed  Google Scholar 

  24. Kombos T, Suess O, Ciklatekerlio O, Brock M, Monitoring of intraoperative motor evoked potentials to increase the safety of surgery in and around the motor cortex J Neurosurg 95: 608–614, 2001

    PubMed  CAS  Google Scholar 

  25. Samset E, Hogetveit JO, Cate GT, Hirschberg H, Integrated neuronavigation system with intraoperative image updating Minim Invasive Neurosurg 48: 73–76, 2005

    Article  PubMed  CAS  Google Scholar 

  26. Schulder M, Liang D, Carmel PW, Cranial surgery navigation aided by a compact intraoperative magnetic resonance imager J Neurosurg 94: 936–945, 2001

    PubMed  CAS  Google Scholar 

  27. Stummer W, Stocker S, Wagner S, Stepp H, Fritsch C, Goetz C, Goetz AE, Kiefmann R, Reulen HJ, Intraoperative detection of malignant gliomas by 5-aminolaevulinic acid-induced porphyrin fluorescence Neurosurgery 42: 518–526, 1998

    Article  PubMed  CAS  Google Scholar 

  28. Shinoda J, Yano H, Yoshimura S, Okumura A, Kaku Y, Iwama T, Sakai M, Fluorescence-guided resection of glioblastoma multiforme by using high-dose fluorescein sodium Technical note J Neurosurg 99: 597–603, 2003

    PubMed  Google Scholar 

  29. Matsumoto K, Tomita S, Ohmoto T, Resection of glioma located in deep or eloquent area: application of functional mapping, intraoperative monitoring and navigation with CT or MRI-assisted stereotactic guidance No Shinkei Geka 25: 17–28, 1997

    PubMed  CAS  Google Scholar 

  30. Schmidinger M, Linzmayer L, Becherer A, Fazeny-Doemer B, Fakhrai N, Prayer D, Killer M, Ungersboeck K, Dieckmann K, Marosi C, Psychometric- and quality-of-life assessment in long-term glioblastoma survivors J Neurooncol 63: 55–61, 2003

    Article  PubMed  Google Scholar 

  31. Koot RW, de Heer K, Oort FJ, Hulshof MC, Bosch DA, de Haes JC, Quality of life after brachytherapy in patients with glioblastoma multiforme Eur J Cancer 40: 1013–1020, 2004

    Article  PubMed  CAS  Google Scholar 

  32. Bampoe J, Laperriere N, Pintilie M, Glen J, Micallef J, Bernstein M, Quality of life in patients with glioblastoma multiforme participating in a randomized study of brachytherapy as a boost treatment J Neurosurg 93: 917–926, 2000

    PubMed  CAS  Google Scholar 

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Correspondence to Koji Kajiwara.

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Yoshikawa, K., Kajiwara, K., Morioka, J. et al. Improvement of functional outcome after radical surgery in glioblastoma patients: the efficacy of a navigation-guided fence-post procedure and neurophysiological monitoring. J Neurooncol 78, 91–97 (2006). https://doi.org/10.1007/s11060-005-9064-2

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  • DOI: https://doi.org/10.1007/s11060-005-9064-2

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