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Gross Total Resection Rates in Contemporary Glioblastoma Surgery: Results of an Institutional Protocol Combining 5-Aminolevulinic Acid Intraoperative Fluorescence Imaging and Brain Mapping

Schucht, Philippe MD*; Beck, Jürgen MD*; Abu-Isa, Janine MD*,‡; Andereggen, Lukas MD*,‡; Murek, Michael MD*; Seidel, Kathleen MD*; Stieglitz, Lennard MD*; Raabe, Andreas MD*

doi: 10.1227/NEU.0b013e31826d1e6b
Research-Human-Clinical Studies
CNS University of Neurosurgery

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.

RESULTS: Fifty-three patients were eligible for GTR/CRET (n = 43 newly diagnosed glioblastoma, n = 10 recurrent); 13 additional patients received surgery for GTR/CRET-ineligible glioblastoma. GTR was achieved in 96% of patients (n = 51, no residual enhancement > 0.175 cm3); CRET was achieved in 89% (n = 47, no residual enhancement). Postoperatively, 2 patients experienced worsening of preoperative hemianopia, 1 patient had a new mild hemiparesis, and another patient sustained sensory deficits.

CONCLUSION: Using 5-aminolevulinic acid imaging and intraoperative mapping/monitoring together leads to a high rate of CRET and an increased rate of GTR compared with the literature without increasing the rate of permanent morbidity. The combination of safety and resection-enhancing intraoperative technologies was likely to be the major drivers for this high rate of CRET/GTR.

ABBREVIATIONS: CRET, complete resection of enhancing tumor

5-ALA, 5-aminolevulinic acid

GTR, gross total resection

IOM, intraoperative monitoring

MEP, motor evoked potential

SSEP, somatosensory evoked potential

*Department of Neurosurgery

Department of Neuroradiology, Bern University Hospital, Bern, Switzerland

Correspondence: Philippe Schucht, MD, Department of Neurosurgery, Bern University Hospital, Bern, Switzerland. E-mail: philippe.schucht@insel.ch

Received January 10, 2012

Accepted July 24, 2012

Copyright © by the Congress of Neurological Surgeons