Bülent GÜLENSOY

Evaluation of the Efficiency of Neuronavigation in Patients with Glioblastoma

Objective: To investigate the effect of neuronavigation use on mortality in patients with glioblastoma. Methods: For each of the 26 patients that underwent neuronavigation-assisted supratotal resection for glioblastoma between 2018 and 2020, one patient that underwent supratotal resection without navigation was selected. Results: Radiographic radicality was observed in 35% of the cases in the neuronavigation-assisted surgery group and 29% of those in the conventional surgery group. Absolute and relative residual tumor volumes were significantly lower in the neuronavigation-assisted surgery group. Radical tumor resection was associated with a very significant increase in survival. There was no significant difference in the survival rates between the patients that underwent surgery with and without neuronavigation. This was attributed to the small number of participants and supratotal resection being performed in all statistically determined patients The low median survival period of glioblastoma may have also contributed to this finding. Conclusions: Surgery plays an important role in the treatment of glioblastoma. A combination of techniques including intraoperative magnetic resonance imaging, neuronavigation, ultrasound, and fluorescence guidance allows for safe and maximum surgical resection, leading to better outcomes in terms of survival and postoperative functional recovery. However, despite maximal surgical resection and adjuvant chemotherapy-radiotherapy, most cases develop tumor recurrence within 10 months, which is considered to be due to established cancer stem cells. Therefore, there is an urgent need to develop more effective treatment strategies for glioblastoma.

Keywords:

Neuronavigation, Glibastoma, Supratotal resection Mortality,

PDF

___

1. Goodenberger M, Jenkins R.B. Genetics of adult glioma. CancerGenet. 2012; 205:613–621.
2. Jäkel S, Dimou L. Glial Cells and Their Function in the Adult Brain: A Journey through the History of Their Ablation. Front. Cell. Neurosci. 2017; 11:24.
3. Wu J, Armstrong T, Gilbert M.R. Biology and management of ependymomas. Neuro-Oncology. 2016; 18:902–913.
4. Bradl M, Lassmann H. Oligodendrocytes: Biology and pathology. Acta Neuropathol. 2009; 119:37–53.
5. Ostrom Q.T, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y et al. CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro-Oncology. 2013;15(Suppl.2):ii1–ii56.
6. Wrensch M, Minn Y, Chew T, Bondy M, Berger M.S. Epidemiology of primary brain tumors: Current concepts and review of the literature. Neuro-Oncology. 2002; 4:278–299.
7. Bleeker F.E, Molenaar R.J, Leenstra S. Recent advances in the molecular understanding of glioblastoma. J. Neuro Oncol. 2012; 108:11–27.
8. Zhang J, Chen X, Zhao Y, Wang F, Li F, Xu B. Impact of Intraoperative Magnetic Resonance Imaging and Functional Neuronavigation on Surgical Outcome in Patients with Gliomas Involving Language Areas. Neurosurg Rev (2015) 38(2):31930; discussion 330. 10.1007/s10143-014-0585-z
9. Zhang J, Chen X, Zhao Y, Wang F, Li F, Xu B. Impact of Intraoperative Magnetic Resonance Imaging and Functional Neuronavigation on Surgical Outcome in Patients with Gliomas Involving Language Areas. Neurosurg Rev (2015) 38(2):31930; discussion 330. 10.1007/s10143-014-0585-z
10. Young R.M, Jamshidi A, Davis G, Sherman J.H. Current trends in the surgical management and treatment of adult glioblastoma. Ann. Transl. Med. 2015; 3:121
11. Brown T.J, Brennan M.C, Li M, Church E.W, Brandmeir N.J, Rakszawski K.L, et al. Association of the Extent of Resection with Survival in Glioblastoma: A Systematic Review and Meta-analysis. JAMA Oncol. 2016; 2:1460–1469.
12. Han Q, Liang H, Cheng P, Yang H, Zhao P. Gross Total vs. Subtotal Resection on Survival Outcomes in Elderly Patients with High-Grade Glioma: A Systematic Review and Meta-Analysis. Front. Oncol. 2020; 10:151.
13. Tunthanathip T, Madteng S. Factors associated with the extent of resection of glioblastoma. Precis. Cancer Med. 2020; 3:12.
14.Ian JG, Marta KO, Kevin P, Denis S, Jeffry AH , Louis C. Brain shift in neuronavigation of brain tumors: A review 2017 Jan; 35:403-420