Neurosurgery

doi: 10.25005/2074-0581-2017-19-4-476-481
RESULTS OF TREATMENT OF GLIAL BRAIN TUMORS

R.G. Ashurov, E.A. Korotkevich, R.R. Sidorovich

Scientific and Practical Center of Neurology and Neurosurgery, Minsk, Republic of Belarus

Objective: To improve the treatment results of patients with brain glioma of varying degrees of malignancy by improving post-operative diagnostics and surgical tactics.

Methods: A retrospective analysis of 843 patients was carried out. Examined indicators of overall survival according to the degree of malignancy of neoplasms and the use of modern surgical technologies. The prospective analysis included 118 patients with brain glioma located in the functionally significant brain zones. Specified patients in addition to the standard neuroimaging study, diffusion-tensor tractography, surgical interventions used neuronavigation, microsurgical and intraoperative neurophysiological monitoring techniques.

Results: Among treated patients with brain gliomas, the 1-, 3-, 5-, and 10-years overall survival probability amounted accordingly 60.9%, 37.6%, 32.3%, and 22.7%, with median survival rates of 1.42 years, respectively. Implementation of both navigation and microsurgery technique during surgery significantly improved long-term outcomes, especially for high level malignant gliomas (p=0,005). When comparing the frequency of postoperative neurologic deficits in the main and control groups, revealed a statistically significant difference (p1=0.049).

Conclusions: The diagnostic algorithm optimization and improvement of the surgical approach contribute to improving the results of treatment in patients with brain gliomas.

Keywords: Brain, glial tumours, surgery, perioperative diagnostics.

Download file:


References
  1. Zozulya Yu A. (red.) Gliomy golovnogo mozga (sovremennoe sostoyanie problemy i puti dal’neyshikh poiskov) [Brain gliomas (Modern state of problem and further ways of search)]. Kiev, Ukraine: EksOb; 2007. 636 p.
  2. Dyachenko AA. Vyzhivaemost’ bol’nykh pervichnymi zlokachestvennymi novoobrazovaniyami tsentral’noy nervnoy sistemy v Arkhangel’skoy oblasti v 2000-2011 gg.: populyatsionno-kogortnoe issledovanie [Elektronnyy resurs] [Survival of patients with primary malignant tumors of central nervous system in Arkhangelsk region in 2000-2011: population and cohort study]. Vestnik Rossiyskogo nauchnogo tsentra rentgenoradiologii. 2013. Vyp. 13.
  3. González-Darder JM, González-López P, Talamantes F, Quilis V, Cortés V, García-March G, et al. Multimodal navigation in the functional microsurgical resection of intrinsic brain tumors located in eloquent motor areas: role of tractography. Neurosurg Focus. 2010;28(2):E5.
  4. Bello L, Gambini A, Castellano A, Carrabba G, Acerbi F, Fava E, et al. Motor and language DTI Fiber Tracking combined with intraoperative subcortical mapping for surgical removal of gliomas. Neuroimage. 2008;39(1): 369-82.
  5. Farshidfar Z, Faeghi F, Mohseni M, Seddighi A, Kharrazi HH, Abdolmohammadi J. Diffusion tensor tractography in the presurgical assessment of cerebral gliomas. The Neuroradiol J. 2014;27(1):75-84.
  6. Duffau H. A new concept of diffuse (low-grade) glioma surgery. Adv and Tech Stand in Neurosurg. 2012;38:3-27.
  7. De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30(20):2259-65.
  8. Moller AR. Intraoperative neurophisiological monitoring. 2nd ed. Louisville, USA: Humana Press Inc.; 2006. 356 p.
  9. Hottinger AF, Stupp R, Homicsko K. Standards of care and novel approaches in the management of glioblastoma multiforme. Chin J of Cancer. 2014;33(1):32- 9.
  10. Noorbakhsh A, Tang JA, Marcus LP, McCutcheon B, Gonda DD, Schallhorn CS, et al. Gross-total resection outcomes in an elderly population with glioblastoma: a SEER-based analysis. J Neurosurg. 2014;120(1):31-9.
  11. Ojemann G, Ojemann J, Lettich E, Berger M. Cortical language localization in left, dominant hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg. 2008;108(2):411-21.
  12. Serra C, Stauffer A, Actor B, Burkhardt JK, Ulrich NH, Bernays RL, et al. Intraoperative high frequency ultrasound in intracerebral high-grade tumors. Ultraschall in der Med. 2012;33(7):E306-E312.
  13. Sanai N, Polley MY, McDermott MW, Parsa AT, Berger MS. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg. 2011;115(1):3-8.
  14. Buchmann N, Gempt J, Stoffel M, Foerschler A, Meyer B, Ringel F. Utility of diffusion tensor-imaged (DTI) motor fiber tracking for the resection of intracranial tumors near the corticospinal tract. Acta Neurochir. 2011;153(1):68-74.
  15. Duffau H. A new concept of diffuse (low-grade) glioma surgery. Adv and Tech Stand in Neurosurg. 2012;38:3-27.
  16. De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30(20):2259-65.
  17. Noorbakhsh A, Tang JA, Marcus LP, McCutcheon B, Gonda DD, Schallhorn CS, et al. Gross-total resection outcomes in an elderly population with glioblastoma: a SEER-based analysis. J Neurosurg. 2014;120(1):31-9.
  18. Snyder LA. The impact of extend of resection on malignant transformation of pure oligodendrogliоmas. J Neurosurg. 2014;120(2):309-14.
  19. Chan-Seng E, Moritz-Gasser S, Duffau H. Awake mapping for low-grade gliomas involving the left sagittal stratum: anatomofunctional and surgical considerations. J Neurosurg. 2014;120(5):1069-77.

Authors informations:

Ashurov Rakhmankul Gurezovich, Candidate of Medical Sciences, Doctoral Candidate of the Neurosurgical Department of the Republican Scientific and Practical Center of Neurology and Neurosurgery

Korotkevich Evgeniy Alexandrovich, Doctor of Medical Sciences, Full Professor, Chief Research Fellow of the Neurosurgical Department of the Republican Scientific and Practical Center of Neurology and Neurosurgery

Sidorovich Rishard Romualdovich, Doctor of Medical Sciences, Director of the Republican Scientific and Practical Center for Neurology and Neurosurgery

Address for correspondence:

Ashurov Rakhmankul Gurezovich

Candidate of Medical Sciences, Doctoral Candidate of the Neurosurgical Department of the Republican Scientific and Practical Center of Neurology and Neurosurgery

220114, Republic of Belarus, Minsk, F. Skorina str., 24

Tel.: (+375) 297 132552

E-mail: rakhmonkul@list.ru

Materials on the topic: