Sabel Video Atlas of Neurophysiological Monitoring in Surgery of Infiltrating Brain Tumors

1. Auflage 2022
ISBN: 978-3-13-258253-8
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 102 Seiten, ePub

A practical and succinct guide to neurophysiological monitoring for safer brain tumor surgery The surgical treatment of infiltrating brain tumors is an extremely challenging and often highly rewarding facet of neurosurgery. The decision-making process involves deeply human interconnections with patients and relatives, cutting-edge neuroscience, and fascinating technology. Video Atlas of Neurophysiological Monitoring in Surgery of Infiltrating Brain Tumors by renowned oncological neurosurgeon Michael Sabel and esteemed contributors demonstrates the practical applications of neurophysiological monitoring to achieve safe removal of infiltrating brain tumors in asleep and awake settings. Organized in three primary parts, the book starts with an introduction including a discussion of the impact and challenges posed by infiltrating gliomas and cerebral metastases and the philosophy behind supramarginal resection. The second part covers critical theoretical components including relevant anatomy, nervous system electricity and fields, transcranial monitoring methods and principles, and direct cortical and subcortical mapping including awake brain surgery. The final part provides insightful, practical guidance on decision making, monitoring set-up, planning of surgical cases, and a summary of accompanying videos.Key HighlightsDiscussion of impacted anatomy, physiology of the neural pathways monitored in brain tumor surgery, and key neurophysiological techniques for monitoring and testing during resectionInstructive illustrations coupled with concise explanations enhance knowledge and facilitate understanding of techniquesFifteen videos covering real-life intraoperative cases provide in-depth insights on applying IONM principles to infiltrating brain tumorsThis is an essential resource for any neurosurgeon involved or interested in brain tumor surgery, from residents and fellows to board-certified neurosurgeons not yet trained in this field.This book includes complimentary access to a digital copy on https://medone.thieme.com.

Zielgruppe

Ärzte

Autoren/Hrsg.

Sabel, Michael Christoph

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Neurochirurgie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Neurologie, Klinische Neurowissenschaft
• Interdisziplinäres Wissenschaften Wissenschaften Interdisziplinär Neurowissenschaften, Kognitionswissenschaft
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Vorklinische Medizin: Grundlagenfächer Physiologie

Inhaltsverzeichnis

Part A: Introduction 1 The Scope of This Book 2 The Challenge to Treat Infiltrating Brain Tumors 3 The Impact of Lesionectomy on the Prognosis of Infiltrating Intracerebral Tumors 4 The Philosophy Behind Supramarginal Resection: Functionality Becomes the Limit Part B: The Theoretical Part 5 The Relevant Anatomy of the Functional Systems 6 What You Need to Know About Electricity 7 Transcranial Monitoring—Methods to Monitor CNS Functions: Principles 8 Direct Cortical and Subcortical Mapping 9 Checklist for Awake Procedure Part C: The Practical Part 10 Introduction to the Practical Part 11 Finding the Indication for Surgery 12 Setting up the Monitoring 13 The Surgery 14 Summary: Key Features from the Video 15 Epilogue

Leseproben

3 The Impact of Lesionectomy on the Prognosis of Infiltrating Intracerebral Tumors 3.1 Evidence for Surgical Resection of Malignant Intracerebral Tumors The role of cytoreductive surgery and complete or even supramarginal surgical resection of infiltrating cerebral tumors is of utmost importance. Therefore, we will briefly review the existing evidence for surgical resection of low- and high-grade gliomas as well as cerebral metastases. 3.2 Low-Grade Gliomas As low-grade gliomas have the very real potential of malignant transformation to high-grade gliomas, they need to be considered as functional glioblastoma multiformes (GBMs) (Fig. 3.1) and need to be considered as a precancerous condition as they exhibit a highly infiltrative growth pattern with a diffuse infiltration of still functional brain areas.1 Therefore, a biological complete resection is likely not possible. If biological complete resection is not possible, does a radical tumor resection of low-grade gliomas translate into an improved prognosis at all? Prospective, randomized, and controlled trials addressing this question are not yet available. However, several retrospective studies suggest a benefit of a radical surgical resection of low-grade gliomas.2,3,4,5,6,7,8,9,10,11 In a population-based parallel cohort analysis of low-grade gliomas in patients from two different Scandinavian hospitals, overall survival after early surgical resection was significantly improved as compared to a biopsy and a “wait-and-watch” strategy.11,12 In a retrospective analysis of over 1000 French low-grade gliomas patients, surgical resection translated into increased malignant progression-free and overall survival following extensive surgical resection.13,14 A recent Dutch study with 228 adult patients with WHO II supratentorial gliomas identified the residual tumor volume after resection as a strong predictor for the overall survival.15 These results confirm earlier evidence where the postoperative tumor volume was a prognostic factor of both the progression-free and overall survival.16,17 Current guidelines advocate, therefore, extensive surgical resection as first therapeutic option.18,19 However, postoperative neurologic deficits are a negative prognostic factor. Therefore, surgery should prevent new perisurgical deficits and a sustained quality of life of patients has a priority over maximization of surgical resection.19 Fig. 3.1 (a-c) Malignant transformation of a (after magnetic resonance imaging [MRI] criteria) low-grade glioma into a high-grade glioma 15 months after diagnosis of the lesion. 3.3 High-Grade Gliomas Compared to low-grade gliomas, malignant gliomas are similarly highly infiltrating but show a worse prognosis. Evidence for cytoreductive surgery for malignant gliomas was demonstrated in retrospective and prospective studies:20 The beneficial effect of a surgical resection as compared to a biopsy alone was demonstrated already in the 1950s and in two later prospective studies.21,22,23 Moreover, the post-hoc analysis of the prospective randomized and controlled 5-amino-laevulinic acid (5-ALA) study with 270 glioblastoma patients comparing conventional with 5-ALA fluorescence-guided resection identified the postoperative tumor volume as prognostic factor for the overall survival.24,25 The later prospective, randomized, and controlled single-center iMRI study with 58 glioblastoma patients analyzed the impact of the use of an intraoperative MRI guidance on extent of resection. As in the 5-ALA study, the more complete tumor resections in the study group translated in a significantly prolonged progression-free survival.24,26 However, the iMRI was neither designed nor powered for a further analysis of a potential effect of extent of surgical resection on overall survival.27 Based on these data, complete surgical resection of malignant gliomas (if feasible) is standard of care and recommended by the current guidelines.26 Again, although complete surgical resection of malignant gliomas should be aimed at, the preservation of the patient’s neurologic integrity is prior to the maximization of surgical resection.19 3.4 Cerebral Metastases In contrast to low- and high-grade gliomas, cerebral metastases are more sharply delimitated from the adjacent brain tissue. Nevertheless, most metastases have the properties of albeit limited, but still relevant, local brain infiltration.27,28,29,30 Therefore, treatment of cerebral metastases should aim at the resection of this limited infiltration zone and therefore aim at a local cure. Evidence for a surgical resection of one to four cerebral metastases have been established from phase III studies from the 1990s comparing whole-brain radiation therapy (WBRT) alone with surgery combined with WBRT. In particular in the studies by Patchell and by Noordijk and Vecht, a combined surgical and adjuvant treatment was associated with a significantly improved overall survival.31,32,33 In nearly all more recent phase III studies, overall survival was more related to the systemic status of cancer patients than to the cranial situation.34,35,36,37,38 However, the beneficial role of lesionectomy for a single, accessible metastasis is unquestionable. In other words, an adequate treatment of a single cerebral metastasis by surgical resection (or single-fraction radiosurgery/irradiation) is the prerequisite to shift the prognosis of cancer patients from the cranial situation to the systemic status. However, prospective and controlled studies relating the residual tumor after surgery to the rate of local recurrences and finally to the overall survival are lacking. Nevertheless, retrospective studies suggest such an association.39 Furthermore, extension of surgical resection toward a supramarginal resection might additionally result in a better local control as compared to conventional metastectomy.28,40,41,42,43,44,45 In conclusion, at least complete surgical resection of a single cerebral metastasis is together with single-fraction radiosurgery the first therapeutic option and advocated by the actual guidelines.46,47,48 References [1]Osswald M, Jung E, Sahm F, et al. Brain tumour cells interconnect to a functional and resistant network. Nature. 2015; 528(7580):93–98 [2]Duffau H, Lopes M, Arthuis F, et al. Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985–96) and with (1996–2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry. 2005; 76(6):845–851 [3]Yeh SA, Ho JT, Lui CC, Huang YJ, Hsiung CY, Huang EY. Treatment outcomes and prognostic factors in patients with supratentorial low-grade gliomas. Br J Radiol. 2005; 78 (927):230–235 [4]McGirt MJ, Chaichana KL, Attenello FJ, et al. Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery. 2008; 63(4):700–707, author reply 707–708 [5]Schomas DA, Laack NN, Brown PD. Low-grade gliomas in older patients: long-term follow-up from Mayo Clinic. Cancer. 2009; 115(17):3969–3978 [6]Schomas DA, Laack NN, Rao RD, et al. Intracranial low-grade gliomas in adults: 30-year experience with long-term follow-up at Mayo Clinic. Neuro-oncol. 2009; 11(4):437– 445 [7]Youland RS, Schomas DA, Brown PD, et al. Changes in presentation, treatment, and outcomes of adult low-grade gliomas over the past fifty years. Neuro-oncol. 2013; 15 (8):1102–1110 [8]Youland RS, Khwaja SS, Schomas DA, Keating GF, Wetjen NM, Laack NN. Prognostic factors and survival patterns in pediatric low-grade gliomas over 4 decades. J Pediatr Hematol Oncol. 2013; 35(3):197–205 [9]Ius T, Isola M, Budai R, et al. Low-grade glioma surgery in eloquent areas: volumetric analysis of extent of resection and its impact on overall survival. A single-institution experience in 190 patients: clinical article. J Neurosurg. 2012; 117(6):1039–1052 [10]Gousias K, Schramm J, Simon M. Extent of resection and survival in supratentorial infiltrative low-grade gliomas: analysis of and adjustment for treatment bias. Acta Neurochir (Wien). 2014; 156(2):327–337 [11]Jakola AS, Myrmel KS, Kloster R, et al. Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA. 2012; 308 (18):1881–1888 [12]Jakola AS, Unsgård G, Myrmel KS, et al. Low grade gliomas in eloquent locations - implications for surgical strategy, survival and long term quality of life. PLoS One. 2012; 7(12): e51450 [13]Capelle L, Fontaine D, Mandonnet E, et al. French Réseau d’Étude des Gliomes. Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases: clinical article. J Neurosurg. 2013; 118(6):1157–1168 [14]Pallud J, Audureau E, Blonski M, et al. Epileptic seizures in diffuse low-grade gliomas in adults. Brain. 2014; 137(Pt 2): 449–462 [15]Wijnenga MMJ, French PJ, Dubbink HJ, et al. The impact of surgery in molecularly defined low-grade glioma: an integrated clinical, radiological, and molecular analysis....