Saratov JOURNAL of Medical and Scientific Research

Surgical treatment of glioblastomas with various MR characteristics

Year: 2020, volume 16 Issue: №4 Pages: 912-916
Heading: neurosurgery Article type: Original article
Authors: Lakhina Yu.S., Gulyaev D.A., Krasnoshlyk P.V., Mitrofanova L.B., Petrov A.A., Belov I.Yu., Chirkin V.Yu.
Organization: The Almazov National Medical Research Centre, Head of Second Cerebral and Spinal Cord Tumors Department, Doctor of Medical Sciences

Objective: To justify the need for intraoperative monitoring (IOM) for surgical treatment of glioblastoma (GB) with various magnetic resonance characteristics. Material and Methods. 59 patients aged 24-76 years operated on for GB were studied. There were 3 observation groups according to the GB type: 1st — without non-contrasting zone (nCEZ) (n=18); 2nd — with non-contrasting part, hyperintensive in T2 FLAIR mode, corresponding to Sawaya I (n=26); 3rd — with hyperintensive in T2 FLAIR mode zone, corresponding to Sawaya II (n=15). Results. In the 1st and 3rd observation groups, all patients managed to achieve radical removal of the tumor, regardless of the use of IOM. In group 2, total removal was achieved in 69.2% of cases. Analysis of the progression-free period in the three groups showed no significant differences (p=0.05). There was a tendency to increase the progression-free period when using IOM (p=0.07). Using IOM significantly increased overall survival (p=0.04). Conclusion. The use of IOM for the surgical treatment of GB with nCEZ infiltrating functionally significant areas of brain contributes to the radical removal of such tumors. Given that the tissue corresponding to the hyperintensive area in the T2 FLAIR mode contains cancer stem cells, has a high potential compared to other components of the tumor and is most often a source for continued growth, the totality of its resection provides the highest duration of the progression-free period.

1. Wang H, Xu T, Jiang Y, et al. The challenges and the promise of molecular targeted therapy in malignant gliomas. Neoplasia 2015; 17 (3): 239-55.
2. Burger PC, Vogel FS, Green SB, Strike ТА. Glioblastoma multiforme and anaplastic astrocytoma. Pathologic criteria and prognostic implications. Cancer 1985; 56 (5): 1106-11.
3. StummerW, Reulen HJ, MeinelT, et al. ALA-Glioma Study Group. Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery 2008; 62 (3): 564-76.
4. De Witt Hamer PC, Robles SG, Zwinderman AH, et al. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol 2012; 30 (20): 2559-65.
5. Lacroix M, Abi-Said D, Fourney DR, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 2001; 95 (2): 190-8.
6. Lang FF, Sawaya R, Suki D, et al. Glioblastoma resection. J Neurosurg 2012; 116(5): 1166-7.
7. Eljamel MS, Mahboob SO. The effectiveness and cost-effectiveness of intraoperative imaging in high-grade glioma resection; a comparative review of intraoperative ALA, fluorescein, ultrasound and MRI. Photodiagnosis Photodyn Ther 2016; (16): 35-43.
8. Gerritsen JKW, Arends L, Klimek M, et al. Impact of intraoperative stimulation mapping on high-grade glioma surgery outcome: a meta-analysis. Acta Neurochir (Wien) 2019; 161 (1): 99-107.
9. Abreu FB de, Gallagher TL, Liu EZ, Tsongalis GJ. Determining methylation status of methylguanine DNA methyl transferase (MGMT) from formalin-fixed, paraffin embedded tumor tissue. Methods X 2014; (1): 42-8.
10. Szelenyi A, Senft C, Jardan M, et al. Intra-operative subcortical electrical stimulation: a comparison of two methods. Clin Neurophysiol 2011; 122 (7): 1470-5.
11. Altrock PM, Liu LL, Michor F. The mathematics of cancer: integrating quantitative models. Nat Rev Cancer 2015; 15 (12): 730-45.
12. Baldock AL, Rockne RC, Boone AD, et al. From patient-specific mathematical neuro-oncology to precision medicine. Front Oncol. 2013; 62(3): 1-11.
13. Altmann C, Keller S, Schmidt MHH. The Role of SVZ Stem Cells in Glioblastoma. Cancers (Basel) 2019; 11 (4): 448.

2020_04_912-916.pdf815.85 KB

No votes yet