Gross Total Resection Rates in Contemporary Glioblastoma Surgery: Results of an Institutional Protocol Combining 5-Aminolevulinic Acid Intraoperative Fluorescence Imaging and Brain Mapping
Gross Total Resection Rates in Contemporary Glioblastoma Surgery: Results of an Institutional Protocol Combining 5-Aminolevulinic Acid Intraoperative Fluorescence Imaging and Brain Mapping
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DOI：
10.1227/neu.0b013e31826d1e6b
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发表时间：
2012-11-01
期刊：
影响因子：
4.8
通讯作者：
Raabe, Andreas
中科院分区：
文献类型：
--
作者：
Schucht, Philippe;Beck, Juergen;Raabe, Andreas
背景：完全切除造影增强肿瘤已被认为是胶质母细胞瘤患者预后的重要因素，也是手术的主要目标。最近，各种术中技术被引入以改善神经胶质瘤手术。目的：评估使用5-氨基乙酰丙酸和术中定位和监测对增强肿瘤完全切除（CRET）、总全切除（GTR）和新神经功能缺损率的影响，作为机构方案的一部分。方法：2008年8月至2010年11月，连续103例患者行胶质母细胞瘤切除术。CRET的资格是基于2位评论者评估的初始磁共振成像。主要终点是CRET和GTR患者的数量。次要终点是剩余对比增强组织的体积和术后新出现的神经功能缺损。结果：53例患者符合GTR/CRET的条件（n = 43例新诊断的胶质母细胞瘤，n = 10例复发）；另外13名患者接受了GTR/ cret不符合条件的胶质母细胞瘤手术。96%的患者实现了GTR (n = 51，无残余增强bb0 0.175 cm(3))；CRET达到89% （n = 47，无残留增强）。术后2例患者术前偏盲加重，1例患者新发轻度偏瘫，1例患者持续感觉障碍。结论：与文献相比，5-氨基乙酰丙酸显像与术中测图/监测联合使用可导致较高的CRET率和较高的GTR率，但不会增加永久性发病率。安全性和术中切除增强技术的结合可能是高CRET/GTR率的主要驱动因素。
BACKGROUND: Complete resection of contrast-enhancing tumor has been recognized as an important prognostic factor in patients with glioblastoma and is a primary goal of surgery. Various intraoperative technologies have recently been introduced to improve glioma surgery.OBJECTIVE: To evaluate the impact of using 5-aminolevulinic acid and intraoperative mapping and monitoring on the rate of complete resection of enhancing tumor (CRET), gross total resection (GTR), and new neurological deficits as part of an institutional protocol.METHODS: One hundred three consecutive patients underwent resection of glioblastoma from August 2008 to November 2010. Eligibility for CRET was based on the initial magnetic resonance imaging assessed by 2 reviewers. The primary end point was the number of patients with CRET and GTR. Secondary end points were volume of residual contrast-enhancing tissue and new postoperative neurological deficits.RESULTS: Fifty-three patients were eligible for GTR/CRET (n = 43 newly diagnosed glioblastoma, n = 10 recurrent); 13 additional patients received surgery for GTR/CRET-ineligible glioblastoma. GTR was achieved in 96% of patients (n = 51, no residual enhancement >0.175 cm(3)); CRET was achieved in 89% (n = 47, no residual enhancement). Postoperatively, 2 patients experienced worsening of preoperative hemianopia, 1 patient had a new mild hemiparesis, and another patient sustained sensory deficits.CONCLUSION: Using 5-aminolevulinic acid imaging and intraoperative mapping/monitoring together leads to a high rate of CRET and an increased rate of GTR compared with the literature without increasing the rate of permanent morbidity. The combination of safety and resection-enhancing intraoperative technologies was likely to be the major drivers for this high rate of CRET/GTR.