Ultrasound-assisted resection of insular gliomas

IF 0.7 Q4 CLINICAL NEUROLOGY Egyptian journal of neurosurgery Pub Date : 2024-05-06 DOI:10.1186/s41984-024-00290-9
Patrick Murithi Kaberia, Ahmed Hafez Farhoud, Mahmoud Abbassy, Anwar Hamed Heikal, Ahmed AbdelAziz Fayed
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Abstract

Insular gliomas’ management challenges are attributed to their complex shape, proximity to critical vasculature, and organization. However, cytoreductive surgery's role in maximal extent of resection (EOR) improves survival. Intraoperative ultrasound (IOUS) aids in defining tumor border, detecting residual, and guiding access. The aim of this study was to assess the impact of using intraoperative ultrasound on the extent of resection of insular gliomas, and the postoperative outcomes in a prospective cohort of 20 patients operated at Alexandria main university hospital and followed up for a period of at least 3 months. The Near total resection rate was 45% with 70% of patients having no neurological morbidity postoperatively. The median EOR was 81% with a range of 44 to 96%. The mean duration of IOUS setup was 19.6 ± 5.04 min, while the additional resection rate following IOUS assessment for residual tumor was 65% (n = 13). In addition, there was a significant increase in Karnofsky Performance Status (KPS) from the preoperative through to the 90-day follow-up period (p = 0.012). Finally, following multivariate linear regression analysis, the EOR was identified as having a statistically significant correlation with the postoperative KPS (p = 0.004). Intraoperative ultrasonography is a valuable modality for strategizing the most efficient route to the tumor, promptly detecting any remaining tumor tissue, and optimizing the extent of resection for insular gliomas, while taking into consideration the phenomenon of brain shift.
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超声辅助切除岛状胶质瘤
岛状胶质瘤的形状复杂、临近重要血管和组织结构,给治疗带来了挑战。然而,细胞切除手术在最大程度切除(EOR)方面的作用提高了患者的生存率。术中超声(IOUS)有助于确定肿瘤边界、检测残留和引导入路。这项研究旨在评估术中超声对岛状胶质瘤切除范围的影响,以及在亚历山大主要大学医院接受手术并随访至少3个月的20名前瞻性患者的术后效果。近全切率为 45%,70% 的患者术后未出现神经系统疾病。EOR中位数为81%,范围在44%至96%之间。IOUS设置的平均持续时间为19.6±5.04分钟,IOUS评估残留肿瘤后的额外切除率为65%(n = 13)。此外,从术前到 90 天的随访期间,Karnofsky 表情状态(KPS)都有显著提高(p = 0.012)。最后,经过多变量线性回归分析,确定 EOR 与术后 KPS 存在统计学意义上的显著相关性(p = 0.004)。术中超声波检查是一种非常有价值的方式,可用于制定通往肿瘤的最有效路径,及时发现残留的肿瘤组织,优化岛状胶质瘤的切除范围,同时考虑到脑转移现象。
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