Abstract
BackgroundComplete resection of enhancing tumor as assessed by early (<72 hours) postoperative MRI is regarded as the optimal result in glioblastoma surgery. As yet, there is no consensus on standard procedure if post-operative imaging reveals unintended tumor remnants.ObjectiveThe current study evaluated the feasibility and safety of an early re-do surgery aimed at completing resections with the aid of 5-ALA fluorescence and neuronavigation after detection of enhancing tumor remnants on post-operative MRI.MethodsFrom October 2008 to October 2012 a single center institutional protocol offered a second surgery within one week to patients with unintentional incomplete glioblastoma resection. We report on the feasibility of the use 5-ALA fluorescence guidance, the extent of resection (EOR) rates and complications of early re-do surgery.ResultsNine of 151 patients (6%) with glioblastoma resections had an unintentional tumor remnant with a volume >0.175 cm3. 5-ALA guided re-do surgery completed the resection (CRET) in all patients without causing neurological deficits, infections or other complications. Patients who underwent a re-do surgery remained hospitalized between surgeries, resulting in a mean length of hospital stay of 11 days (range 7-15), compared to 9 days for single surgery (range 3-23; p=0.147).ConclusionOur early re-do protocol led to complete resection of all enhancing tumor in all cases without any new neurological deficits and thus provides a similar oncological result as intraoperative MRI (iMRI). The repeated use of 5-ALA induced fluorescence, used for identification of small remnants, remains highly sensitive and specific in the setting of re-do surgery. Early re-do surgery is a feasible and safe strategy to complete unintended subtotal resections.
Highlights
The resection of enhancing tumor is known to prolong progression free and overall survival [1,2]
The introduction of 5-amino levulinic acid (5-ALA) as an intra-operative tumor detection agent significantly increases the likelihood of achieving a GTR, which previously was only achieved in a minority of patients [3,4,5,6]
A recent randomized controlled trial showed an increased rate of achieved GTR using intraoperative MRI (iMRI) compared to surgeries without iMRI (96% achieved GTR with iMRI versus 68% without iMRI, no 5-ALA used) [16], confirming the advantage of iMRI for improving the extent of resection in surgery for malignant glioma
Summary
The resection of enhancing tumor (gross total resection, GTR) is known to prolong progression free and overall survival [1,2]. An early post-operative MRI (within 72 hours) is commonly used to verify whether a complete resection of enhancing tumor has been achieved [3]. Complete resection of enhancing tumor as assessed by early (
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
