Ahead of Print: Residual Fluorescence Value in Glioblastomas

Background: There is evidence in the literature that supports fluorescent tissue signal in fluorescence guided surgery (FGS) extends farther than tissue highlighted in T1Gd MRI, which is the standard to quantify the extent of resection (EOR).

Objective: To study whether the presence of residual fluorescent tissue after surgery carries a different prognosis for glioblastoma (GBM) cases with complete resection confirmed by MRI.

Methods: A retrospective review in our center found 118 consecutive patients with high-grade gliomas operated using 5-aminolevulinic acid (5-ALA) FGS. Within that series, the 52 patients with newly diagnosed GBM and complete resection of enhancing tumor (CRET) in early MRI were selected for analysis. We studied the influence of residual fluorescence in the surgical field on overall survival and neurological complication rate. Multivariate analysis included potential relevant factors: age, Karnofsky Performance Scale (KPS), MGMT methylation promoter status, tumor eloquent location, preoperative tumor volume, and adjuvant therapy.

Ahead of Print: Differentiating Human Astrocytomas Using MRS

Background: Astrocytomas are primary brain tumors in which the prognosis and treatment vary depending on the grade of the tumor, necessitating a precise preoperative classification. Magnetic resonance spectroscopy (MRS) provides information about metabolites in tissues and is an emerging noninvasive tool to improve diagnostic accuracy in patients with intracranial neoplasia.

Objective: To investigate whether ex vivo MRS could differentiate WHO grade II (A-II) and IV astrocytomas (glioblastomas; GBM), and to correlate MR spectral profiles with clinical parameters.

Methods: Patients with A-II and GBM (n=58) scheduled for surgical resection were enrolled. Tumor specimens were collected during surgery and stored in liquid nitrogen before being analyzed with high resolution magic angle spinning (HR-MAS) MRS. The tumors were histopathologically classified according to WHO criteria as GBM (n=48) and A-II (n=10).

Ahead of Print: Increased xCT Expression in GBM

Background: xCT is a light chain of the cystine/glutamate antiporter system xc-. Glutamate that is released by system xc- plays an important role in the infiltration of glioblastoma (GBM) cells. Furthermore, increased glutathione synthesis by system xc- may protect tumor cells from oxidative stress induced by radiotherapy and chemotherapy.

Objective: To investigate whether the levels of xCT expression correlated with infiltrative imaging phenotypes on magnetic resonance imaging (MRI) and outcomes in patients with GBMs.

Methods: Forty patients with histologically confirmed primary GBM were included in the present study. Patient charts were retrospectively reviewed for age, sex, Karnofsky performance status (KPS), mini-mental state examination scores, MRI features, xCT expression, isocitrate dehydrogenase 1 (IDH1) R132H expression, O6-methylguanine-DNA methyltransferase promoter methylation status, type of surgery, progression-free survival (PFS), and overall survival (OS).

Free CME Article: Gross Total Resection Rates in Contemporary Glioblastoma Surgery

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.

Ahead of Print: Neurosurgical Management and Prognosis of Patients with Glioblastoma that Progress During Bevacizumab Treatment

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BACKGROUND: The management and prognosis of glioblastoma patients after Stupp protocol treatment and progression during bevacizumab (BV) treatment remains undefined.

OBJECTIVE: We compared the morbidity and survival of patients whose glioblastomas progressed during bevacizumab treatment requiring craniotomy to non-bevacizumab-treated patients.

METHODS: We retrospectively reviewed patients who underwent craniotomy for recurrent glioblastoma from 2005-2009. Patients operated on for progression during bevacizumab (preoperative bevacizumab) were compared to patients receiving no bevacizumab or bevacizumab after surgery (postoperative bevacizumab). Preoperative bevacizumab patients were compared to those progressing on bevacizumab but not operated on (no surgery).