Combined use of multimodal techniques for the resection of glioblastoma involving corpus callosum

Meng Cui,Guochen Sun,Xiaodong Ma,Caihong Sun,Hepu Lin,Jialin Liu,Hewen Chen,Meng Zhang

doi:10.1007/s00701-021-05008-6

Meng Cui, Guochen Sun + Show 6 more

Open Access

https://doi.org/10.1007/s00701-021-05008-6

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Abstract

PurposeTo compare the multimodal techniques (including neuronavigation, intraoperative MRI [iMRI], and neuromonitoring [IONM]) and conventional approach (only guided by neuronavigation) in removing glioblastoma (GBM) with corpus callosum (CC) involvement (ccGBM), their effectiveness and safety were analyzed and compared.MethodsElectronic medical records were retrospectively reviewed for ccGBM cases treated in our hospital between January 2016 and July 2020. Patient demographics, tumor characteristics, clinical outcomes, extent of resection (EOR), progression-free survival (PFS), and overall survival (OS) were obtained and compared between the multimodal group (used multimodal techniques) and the conventional group (only used neuronavigation). Both groups only included patients that had maximal safe resection (not biopsy). Postoperative radiochemotherapy was also performed or not. Univariate and multivariate analyses were performed to identify significant prognostic factors and optimal EOR threshold.ResultsFinally 56 cases of the multimodal group and 21 cases of the conventional group were included. The multimodal group achieved a higher median EOR (100% versus 96.1%, P = 0.036) and gross total resection rate (60.7% versus 33.3%, P = 0.032) and a lower rate of permanent motor deficits (5.4% versus 23.8%, P = 0.052) than the conventional approach. The multimodal group had the longer median PFS (10.9 versus 7.0 months, P = 0.023) and OS (16.1 versus 11.6 months, P = 0.044) than the conventional group. Postoperative language and cognitive function were similar between the two groups. In multivariate analysis, a higher EOR, radiotherapy, and longer cycles of temozolomide chemotherapy were positive prognostic factors for survival of ccGBM. An optimal EOR threshold of 92% was found to significantly benefit the PFS (HR = 0.51, P = 0.036) and OS (HR = 0.49, P = 0.025) of ccGBM.ConclusionCombined use of multimodal techniques can optimize the safe removal of ccGBM. Aggressive resection of EOR > 92% using multimodal techniques combined with postoperative radiochemotherapy should be suggested for ccGBM.

Highlights

Gliomas are the most common primary intracranial tumor, representing 81% of malignant brain tumors
We aimed to identify factors that affect the survival of ccGBM and the optimal threshold of extent of resection (EOR) for ccGBM
77 cases of ccGBM that underwent resection were included: 56 cases (27 butterfly GBM (bGBM) and 29 non-butterfly ccGBM) were performed resection by using multimodal techniques and 21 cases (9 bGBM and 12 non-butterfly ccGBM) were performed resection only guided by neuronavigation

Summary

Introduction

Gliomas are the most common primary intracranial tumor, representing 81% of malignant brain tumors. Relatively rare, they cause significant mortality and morbidity. Glioblastoma (GBM) is the most invasive type of gliomas, with overall incidence rates ranging from 0.59 to 3.69 per 100,000 persons [32]. GBM is very invasive, typically infiltrating along white matter tracts [17]. As the largest interhemispheric fiber bundle in the human brain, the corpus callosum (CC) is frequently invaded by GBM. The GBM with CC involvement (ccGBM) can be classified as two types. The lesion only invades one side of the

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