Surgical management of periventricular glioma: decision-making and preoperative assessment of resectability
Objective. Periventricular gliomas (PVG) are deep-seated tumors with wide invasion into cerebral core structures accompanied by high rates of postoperative deterioration and early relapse.
The purpose of this study was to define the preoperative neuroimaging signs as the factors determining the early postoperative outcome in patients with high-grade PVG.
Materials and methods. The clinical records of 132 (50 females and 82 males) consecutive patients with a mean age 45.9 years (range 21–69) undergoing image-guided surgery for PVG at a single academic institution were retrospectively analyzed. There were 52 (39.4 %) WHO grade III gliomas, and 80 (60.6 %) of patients had WHO grade IV gliomas.
Results. Postoperative median KPS score significantly raised from 67.4 to 82.0, as well as a number of patients with the KPS score ≥ 70: from 18 (13.6 %) to 109 (82.6 %) with p<0.01. The multivariate regression analysis revealed that poor postoperative functional status was associated with basal ganglia involvement (OR 2.75, 95% CI 0.93–8.09, p = 0.07), the higher EOR grade (OR 3.30, 95% CI 1.15–9.43, p = 0.03), and hydrocephalus (OR 5.08, 95% CI 1.49–17.35, p = 0.09).
Total/subtotal resection was carried out in 84 (63.6 %) cases; in 48 (36.4 %) cases, the partial resection was performed. The multivariate logistic regression analysis revealed that three factors decreased the likelihood of total/subtotal resection in PVG: basal ganglia invasion (OR 0.18, 95% CI 0.06–0.55, p<0.01), minor extraventricular part (OR 0.40, 95% CI 0.17–0.94, p = 0.04), and contralateral side extension (OR 0.38, 95% CI 0.16–0.92, p = 0.03). In contrast, the presence of tumor-associated cyst (OR 3,73, 95% CI 1.32–10.54, p = 0.01) increased odds of total/subtotal resection. The four-tear grading system of PVG integrating statistically identified factors of total/subtotal resection and risks of postoperative neurological deterioration was developed.
The Kaplan-Meier analysis showed that overall median survival was 17.7 ± 1.9 months for patients with high-grade PVG. The survival analysis using Cox regression model revealed that age over 45 years (HR 1.77, 95% CI 1.06–2.99; p = 0.03) and higher tumor WHO grade (HR 2.24, 95% CI 1.27–3.95; p = 0.005) significantly decreased survival rates.
Conclusions. The proposed grading system provides the possibility of preoperative evaluation of PVG resectability that in combination with 3D surgical planning and image-guided resection allows performing maximal safe resections and preventing of postoperative neurological deficits.
2. Ostrom QT, Gittleman H, Liao P, Vecchione-Koval T, Wolinsky Y, Kruchko C, Barnholtz-Sloan JS. CBTRUS Statistical Report: Primary brain and other central nervous system tumors diagnosed in the United States in 2010-2014. Neuro Oncol. 2017 Nov 6;19(suppl_5):v1-v88. [CrossRef] [PubMed] [PubMed Central]
3. Gil-Robles S, Duffau H. Surgical management of World Health Organization Grade II gliomas in eloquent areas: the necessity of preserving a margin around functional structures. Neurosurg Focus. 2010 Feb;28(2):E8. [CrossRef] [PubMed]
4. Parsa AT, Wachhorst S, Lamborn KR, Prados MD, McDermott MW, Berger MS, Chang SM. Prognostic significance of intracranial dissemination of glioblastoma multiforme in adults. J Neurosurg. 2005 Apr;102(4):622-8. [PubMed]
5. Adeberg S, Bostel T, Kцnig L, Welzel T, Debus J, Combs SE. A comparison of long-term survivors and short-term survivors with glioblastoma, subventricular zone involvement: a predictive factor for survival? Radiat Oncol. 2014 Apr 23;9:95. [CrossRef] [PubMed] [PubMed Central]
6. Yang W, Xu T, Garzon-Muvdi T, Jiang C, Huang J, Chaichana KL. Survival of Ventricular and Periventricular High-Grade Gliomas: A Surveillance, Epidemiology, and End Results Program-Based Study. World Neurosurg. 2018 Mar;111:e323-e334. [CrossRef] [PubMed]
7. D'Angelo VA, Galarza M, Catapano D, Monte V, Bisceglia M, Carosi I. Lateral ventricle tumors: surgical strategies according to tumor origin and development--a series of 72 cases. Neurosurgery. 2008 Jun;62(6 Suppl 3):1066-75. [CrossRef] [PubMed]
8. Eliyas JK, Glynn R, Kulwin CG, Rovin R, Young R, Alzate J, Pradilla G, Shah MV, Kassam A, Ciric I, Bailes J. Minimally Invasive Transsulcal Resection of Intraventricular and Periventricular Lesions Through a Tubular Retractor System: Multicentric Experience and Results. World Neurosurg. 2016 Jun;90:556-564. [CrossRef] [PubMed]
9. Stummer W, Reulen HJ, Meinel T, Pichlmeier U, Schumacher W, Tonn JC, Rohde V, Oppel F, Turowski B, Woiciechowsky C, Franz K, Pietsch T; ALA-Glioma Study Group. Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery. 2008 Mar;62(3):564-76; discussion 564-76. [CrossRef] [PubMed]
11. González-Darder JM, González-López P, Talamantes F, Quilis V, Cortés V, García-March G, Roldán P. Multimodal navigation in the functional microsurgical resection of intrinsic brain tumors located in eloquent motor areas: role of tractography. Neurosurg Focus. 2010 Feb;28(2):E5. [CrossRef] [PubMed]
12. Delgado-López PD, Corrales-García EM. Survival in glioblastoma: a review on the impact of treatment modalities. Clin Transl Oncol. 2016 Nov;18(11):1062-1071. [PubMed]
13. Senft C, Forster MT, Bink A, Mittelbronn M, Franz K, Seifert V, Szelényi A. Optimizing the extent of resection in eloquently located gliomas by combining intraoperative MRI guidance with intraoperative neurophysiological monitoring. J Neurooncol. 2012 Aug;109(1):81-90. [CrossRef] [PubMed]
14. Wolbers JG. Novel strategies in glioblastoma surgery aim at safe, supra-maximum resection in conjunction with local therapies. Chin J Cancer. 2014 Jan;33(1):8-15. [CrossRef] [PubMed] [PubMed Central]
15. Li YM, Suki D, Hess K, Sawaya R. The influence of maximum safe resection of glioblastoma on survival in 1229 patients: Can we do better than gross-total resection? J Neurosurg. 2016 Apr;124(4):977-88. [CrossRef] [PubMed]
16. Eyьpoglu IY, Hore N, Savaskan NE, Grummich P, Roessler K, Buchfelder M, Ganslandt O. Improving the extent of malignant glioma resection by dual intraoperative visualization approach. PLoS One. 2012;7(9):e44885. [CrossRef] [PubMed] [PubMed Central]
17. Chaichana KL, Jusue-Torres I, Navarro-Ramirez R, Raza SM, Pascual-Gallego M, Ibrahim A, Hernandez-Hermann M, Gomez L, Ye X, Weingart JD, Olivi A, Blakeley J, Gallia GL, Lim M, Brem H, Quinones-Hinojosa A. Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma. Neuro Oncol. 2014 Jan;16(1):113-22. [CrossRef] [PubMed] [PubMed Central]
18. Mampre D, Ehresman J, Pinilla-Monsalve G, Osorio MAG, Olivi A, Quinones-Hinojosa A, Chaichana KL. Extending the resection beyond the contrast-enhancement for glioblastoma: feasibility, efficacy, and outcomes. Br J Neurosurg. 2018 Oct;32(5):528-535. [CrossRef] [PubMed]
19. Grabowski MM, Recinos PF, Nowacki AS, Schroeder JL, Angelov L, Barnett GH, Vogelbaum MA. Residual tumor volume versus extent of resection: predictors of survival after surgery for glioblastoma. J Neurosurg. 2014 Nov;121(5):1115-23. [CrossRef] [PubMed]
20. Kuhnt D, Becker A, Ganslandt O, Bauer M, Buchfelder M, Nimsky C. Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field intraoperative MRI guidance. Neuro Oncol. 2011 Dec;13(12):1339-48. [CrossRef] [PubMed] [PubMed Central]
21. Sanai N, Tramontin AD, Quiсones-Hinojosa A, Barbaro NM, Gupta N, Kunwar S, Lawton MT, McDermott MW, Parsa AT, Manuel-Garcнa Verdugo J, Berger MS, Alvarez-Buylla A. Unique astrocyte ribbon in adult human brain contains neural stem cells but lacks chain migration. Nature. 2004 Feb 19;427(6976):740-4. [CrossRef] [PubMed]
24. Chaichana KL, McGirt MJ, Frazier J, Attenello F, Guerrero-Cazares H, Quinones-Hinojosa A. Relationship of glioblastoma multiforme to the lateral ventricles predicts survival following tumor resection. J Neurooncol. 2008 Sep;89(2):219-24. [CrossRef] [PubMed]
25. Lim DA, Cha S, Mayo MC, Chen MH, Keles E, VandenBerg S, Berger MS. Relationship of glioblastoma multiforme to neural stem cell regions predicts invasive and multifocal tumor phenotype. Neuro Oncol. 2007 Oct;9(4):424-9. [CrossRef] [PubMed] [PubMed Central]
26. Jafri NF, Clarke JL, Weinberg V, Barani IJ, Cha S. Relationship of glioblastoma multiforme to the subventricular zone is associated with survival. Neuro Oncol. 2013 Jan;15(1):91-6. [CrossRef] [PubMed] [PubMed Central]
27. Vorster SJ, Barnett GH. A proposed preoperative grading scheme to assess risk for surgical resection of primary and secondary intraaxial supratentorial brain tumors. Neurosurg Focus. 1998 Jun 15;4(6):e2. [CrossRef] [PubMed]
28. Litofsky NS, Bauer AM, Kasper RS, Sullivan CM, Dabbous OH; Glioma Outcomes Project Investigators. Image-guided resection of high-grade glioma: patient selection factors and outcome. Neurosurg Focus. 2006 Apr 15;20(4):E16. [CrossRef] [PubMed]
29. Chaichana K, Parker S, Olivi A, Quiсones-Hinojosa A. A proposed classification system that projects outcomes based on preoperative variables for adult patients with glioblastoma multiforme. J Neurosurg. 2010 May;112(5):997-1004. [CrossRef] [PubMed]
30. McGirt MJ, Chaichana KL, Gathinji M, Attenello FJ, Than K, Olivi A, Weingart JD, Brem H, Quiсones-Hinojosa AR. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg. 2009 Jan;110(1):156-62. [CrossRef] [PubMed]
31. Chaichana KL, Pendleton C, Chambless L, Camara-Quintana J, Nathan JK, Hassam-Malani L, Li G, Harsh GR 4th, Thompson RC, Lim M, Quinones-Hinojosa A. Multi-institutional validation of a preoperative scoring system which predicts survival for patients with glioblastoma. J Clin Neurosci. 2013 Oct;20(10):1422-6. [CrossRef] [PubMed] [PubMed Central]
32. Marcus HJ, Williams S, Hughes-Hallett A, Camp SJ, Nandi D, Thorne L. Predicting surgical outcome in patients with glioblastoma multiforme using pre-operative magnetic resonance imaging: development and preliminary validation of a grading system. Neurosurg Rev. 2017 Oct;40(4):621-631. [CrossRef] [PubMed] [PubMed Central]
GOST Style Citations
Copyright (c) 2019 Artem V. Rozumenko, Valentyn M. Kliuchka, Volodymyr D. Rozumenko, Andrii V. Dashchakovskyi, Zoja P. Fedorenko
This work is licensed under a Creative Commons Attribution 4.0 International License.