Skip to main content

Maximal Safe Resection in Glioblastoma: Use of Adjuncts

  • Chapter
  • First Online:
Advances in Biology and Treatment of Glioblastoma

Abstract

Glioblastoma is a malignant primary brain neoplasm for which no cure exists due to the infiltrative nature of this tumor. Maximal safe resection is the cornerstone of treatment that was shown to prolong patient survival. To maximize the extent of resection while preserving neurological status of the patient, good understanding of tumor anatomy as well as location of eloquent cortex and subcortical pathways is required. A number of imaging and functional adjuncts can be used before and during surgery to achieve both of these goals. This chapter first describes the use of preoperative adjuncts such as functional MRI, diffusion tensor imaging, navigated transcranial magnetic stimulation, and others, to help with preoperative planning. Furthermore, it describes the principles of intraoperative techniques such as fluorescence, direct electrical stimulation, and awake craniotomy, that allow intraoperative visualization of tumor tissue as well as mapping of functional cortical and subcortical areas to safely accomplish maximal tumor resection.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Axelson, H.W., G. Hesselager, and R. Flink. 2009. Successful localization of the Broca area with short-train pulses instead of “Penfield” stimulation. Seizure 18: 374–375.

    Article  PubMed  Google Scholar 

  • Cedzich, C., M. Taniguchi, S. Schäfer, and J. Schramm. 1996. Somatosensory evoked potential phase reversal and direct motor cortex stimulation during surgery in and around the central region. Neurosurgery 38: 962–970.

    Article  CAS  PubMed  Google Scholar 

  • Chang, E.F., K.P. Raygor, and M.S. Berger. 2015. Contemporary model of language organization: An overview for neurosurgeons. Journal of Neurosurgery 122: 250–261.

    Google Scholar 

  • Coburger, J., A. Merkel, M. Scherer, F. Schwartz, F. Gessler, C. Roder, et al. 2016. Low-grade glioma surgery in intraoperative magnetic resonance imaging: Results of a multicenter retrospective assessment of the German study group for intraoperative magnetic resonance imaging. Neurosurgery 78: 775–786.

    Article  PubMed  Google Scholar 

  • Fouke, S.J., T. Benzinger, D. Gibson, T.C. Ryken, S.N. Kalkanis, and J.J. Olson. 2015. The role of imaging in the management of adults with diffuse low grade glioma. Journal of Neuro-Oncology 125: 457–479.

    Article  PubMed  Google Scholar 

  • Frey, D., S. Schilt, V. Strack, A. Zdunczyk, J. Rösler, B. Niraula, et al. 2014. Navigated transcranial magnetic stimulation improves the treatment outcome in patients with brain tumors in motor eloquent locations. Neuro-Oncology 16: 1365–1372.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gerganov, V.M., A. Samii, M. Giordano, M. Samii, and R. Fahlbusch. 2011. Two-dimensional high-end ultrasound imaging compared to intraoperative MRI during resection of low-grade gliomas. Journal of Clinical Neuroscience 18: 669–673.

    Article  PubMed  Google Scholar 

  • Hervey-Jumper, S.L., J. Li, D. Lau, A.M. Molinaro, D.W. Perry, L. Meng, et al. 2015. Awake craniotomy to maximize glioma resection: Methods and technical nuances over a 27-year period. Journal of Neurosurgery 123: 325–339.

    Google Scholar 

  • Jakola, A.S., K.S. Myrmel, R. Kloster, S.H. Torp, S. Lindal, G. Unsgård, et al. 2012. Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA 308: 1881–1888.

    Article  CAS  PubMed  Google Scholar 

  • Knauth, M., C.R. Wirtz, V.M. Tronnier, N. Aras, S. Kunze, and K. Sartor. 1999. Intraoperative MR imaging increases the extent of tumor resection in patients with high-grade gliomas. AJNR. American Journal of Neuroradiology 20: 1642–1646.

    CAS  PubMed  Google Scholar 

  • Kombos, T., O. Suess, O. Ciklatekerlio, and M. Brock. 2001. Monitoring of intraoperative motor evoked potentials to increase the safety of surgery in and around the motor cortex. Journal of Neurosurgery 95: 608–614.

    Article  CAS  PubMed  Google Scholar 

  • Korvenoja, A., E. Kirveskari, H.J. Aronen, S. Avikainen, A. Brander, J. Huttunen, et al. 2006. Sensorimotor cortex localization: comparison of magnetoencephalography, functional MR imaging, and intraoperative cortical mapping. Radiology 241: 213–222.

    Article  PubMed  Google Scholar 

  • Krieg, S.M., J. Sabih, L. Bulubasova, T. Obermueller, C. Negwer, I. Janssen, et al. 2014. Preoperative motor mapping by navigated transcranial magnetic brain stimulation improves outcome for motor eloquent lesions. Neuro-Oncology 16: 1274–1282.

    Article  PubMed  PubMed Central  Google Scholar 

  • Krieg, S.M., E. Shiban, N. Buchmann, J. Gempt, A. Foerschler, B. Meyer, et al. 2012a. Utility of presurgical navigated transcranial magnetic brain stimulation for the resection of tumors in eloquent motor areas. Journal of Neurosurgery 116: 994–1001.

    Article  PubMed  Google Scholar 

  • Krieg, S.M., E. Shiban, D. Droese, J. Gempt, N. Buchmann, H. Pape, et al. 2012b. Predictive value and safety of intraoperative neurophysiological monitoring with motor evoked potentials in Glioma surgery. Neurosurgery 70: 1060–1071.

    Article  PubMed  Google Scholar 

  • Krings, T., M. Schreckenberger, V. Rohde, U. Spetzger, O. Sabri, M.H.T. Reinges, et al. 2002. Functional MRI and 18F FDG-positron emission tomography for presurgical planning: Comparison with electrical cortical stimulation. Acta Neurochir (Wien) 144:889–99– discussion 899.

    Google Scholar 

  • Kuchcinski, G., C. Mellerio, J. Pallud, E. Dezamis, G. Turc, O. Rigaux-Viodé, et al. 2015. Three-tesla functional MR language mapping: Comparison with direct cortical stimulation in gliomas. Neurology 84: 560–568.

    Article  CAS  PubMed  Google Scholar 

  • Kumar, V.A., J. Hamilton, L.A. Hayman, A.J. Kumar, G. Rao, J.S. Weinberg, et al. 2013. Deformable anatomic templates improve analysis of gliomas with minimal mass effect in eloquent areas. Neurosurgery 73: 534–542.

    Article  PubMed  Google Scholar 

  • Lacroix, M., D. Abi-Said, D.R. Fourney, Z.L. Gokaslan, W. Shi, F. DeMonte, et al. 2001. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. Journal of Neurosurgery 95: 190–198.

    Article  CAS  PubMed  Google Scholar 

  • Le Roux, P.D., M.S. Berger, K. Wang, L.A. Mack, and G.A. Ojemann. 1992. Low grade gliomas: comparison of intraoperative ultrasound characteristics with preoperative imaging studies. Journal of Neuro-Oncology 13: 189–198.

    Google Scholar 

  • Lefaucheur, J.-P., and T. Picht. 2016. The value of preoperative functional cortical mapping using navigated TMS. Neurophysiologie clinique = Clinical neurophysiology 46: 125–133.

    Article  PubMed  Google Scholar 

  • Li, Y.M., D. Suki, K. Hess, and R. Sawaya. 2016. The influence of maximum safe resection of glioblastoma on survival in 1229 patients: Can we do better than gross-total resection? Journal of Neurosurgery 124: 977–988.

    Article  PubMed  Google Scholar 

  • McGirt, M.J., D. Mukherjee, K.L. Chaichana, K.D. Than, J.D. Weingart, A. Quinones-Hinojosa. 2009. Association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme. Neurosurgery 65:463–9– discussion 469–70.

    Google Scholar 

  • Nabavi, A., H. Thurm, B. Zountsas, T. Pietsch, H. Lanfermann, U. Pichlmeier, et al. 2009. Five-aminolevulinic acid for fluorescence-guided resection of recurrent malignant gliomas: A phase ii study. Neurosurgery 65:1070–6– discussion 1076–7.

    Google Scholar 

  • Nimsky, C., O. Ganslandt, P. Hastreiter, R. Wang, T. Benner, A.G. Sorensen, et al. 2007. Preoperative and intraoperative diffusion tensor imaging-based fiber tracking in glioma surgery. Neurosurgery 61:178–85– discussion 186

    Google Scholar 

  • Nossek, E., A. Korn, T. Shahar, A.A. Kanner, H. Yaffe, D. Marcovici, et al. 2011. Intraoperative mapping and monitoring of the corticospinal tracts with neurophysiological assessment and 3-dimensional ultrasonography-based navigation. Clinical article. Journal of Neurosurgery 114: 738–746.

    Article  PubMed  Google Scholar 

  • Nossek, E., I. Matot, T. Shahar, O. Barzilai, Y. Rapoport, T. Gonen, et al. 2013. Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor. Journal of Neurosurgery 118: 243–249.

    Article  PubMed  Google Scholar 

  • Ohue, S., S. Kohno, A. Inoue, D. Yamashita, H. Harada, Y. Kumon, et al. 2012. Accuracy of diffusion tensor magnetic resonance imaging-based tractography for surgery of gliomas near the pyramidal tract: A significant correlation between subcortical electrical stimulation and postoperative tractography. Neurosurgery 70:283–93– discussion 294.

    Google Scholar 

  • Penfield, W., E. Boldrey. 1937. Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain 60: 389–443.

    Google Scholar 

  • Picht, T., D. Frey, S. Thieme, S. Kliesch, and P. Vajkoczy. 2016. Presurgical navigated TMS motor cortex mapping improves outcome in glioblastoma surgery: a controlled observational study. Journal of Neuro-Oncology 126: 535–543.

    Article  PubMed  Google Scholar 

  • Prabhu, S.S., J. Gasco, S. Tummala, J.S. Weinberg, and G. Rao. 2011. Intraoperative magnetic resonance imaging-guided tractography with integrated monopolar subcortical functional mapping for resection of brain tumors. Clinical article. Journal of Neurosurgery 114: 719–726.

    Article  PubMed  Google Scholar 

  • Prada, F., l. Mattei, M. Del Bene, L. Aiani, M. Saini, C. Casali, A. Filippini, F.G. Legnani, A. Perin, A. Saladino, I.G. Vetrano, L. Solbiati, A. Martegani, and F. DiMeco, 2014. Clinical StudyIntraoperative Cerebral Glioma Characterization with Contrast Enhanced Ultrasound. BioMed Research International 2014, 1–9. doi:10.1155/2014/484261.

  • Pujol, S., W. Wells, C. Pierpaoli, C. Brun, J. Gee, G. Cheng, et al. 2015. The DTI challenge: Toward standardized evaluation of diffusion tensor imaging tractography for neurosurgery. Journal of Neuroimaging 25: 875–882.

    Article  PubMed  PubMed Central  Google Scholar 

  • Raabe, A., J. Beck, P. Schucht, and K. Seidel. 2014. Continuous dynamic mapping of the corticospinal tract during surgery of motor eloquent brain tumors: evaluation of a new method. Journal of Neurosurgery 120: 1015–1024.

    Article  PubMed  Google Scholar 

  • Rivaz, H., S.J.-S. Chen, and D.L. Collins. 2015. Automatic deformable MR-ultrasound registration for image-guided neurosurgery. IEEE Transactions on Medical Imaging 34: 366–380.

    Article  PubMed  Google Scholar 

  • Sanai, N., M.-Y. Polley, M.W. McDermott, A.T. Parsa, and M.S. berger. 2011. An extent of resection threshold for newly diagnosed glioblastomas. Journal of Neurosurgery 115: 3–8.

    Article  PubMed  Google Scholar 

  • Schreiber, A., U. Hubbe, S. Ziyeh, and J. Hennig. 2000. The influence of gliomas and nonglial space-occupying lesions on blood-oxygen-level-dependent contrast enhancement. AJNR. American Journal of Neuroradiology 21: 1055–1063.

    CAS  PubMed  Google Scholar 

  • Seidel, K., J. Beck, L. Stieglitz, P. Schucht, and A. Raabe. 2013. The warning-sign hierarchy between quantitative subcortical motor mapping and continuous motor evoked potential monitoring during resection of supratentorial brain tumors. Journal of Neurosurgery 118: 287–296.

    Article  PubMed  Google Scholar 

  • Senft, C., A. Bink, K. Franz, H. Vatter, T. Gasser, and V. Seifert. 2011. Intraoperative MRI guidance and extent of resection in glioma surgery: A randomised, controlled trial. The Lancet Oncology 12: 997–1003.

    Article  PubMed  Google Scholar 

  • Serra, C., A. Stauffer, B. Actor, J.-K. Burkhardt, N.H.-B. Ulrich, R.-L. Bernays, et al. 2012. Intraoperative high frequency ultrasound in intracerebral high-grade tumors. Ultraschall in der Medizin 33: E306–E312.

    Article  CAS  PubMed  Google Scholar 

  • Stummer, W., U. Pichlmeier, T. Meinel, O.D. Wiestler, F. Zanella, H.-J. Reulen, et al. 2006. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: A randomised controlled multicentre phase III trial. Lancet Oncology 7: 392–401.

    Article  CAS  PubMed  Google Scholar 

  • Taniguchi, M., C. Cedzich, and J. Schramm. 1993. Modification of cortical stimulation for motor evoked potentials under general anesthesia: Technical description. Neurosurgery 32: 219–226.

    Article  CAS  PubMed  Google Scholar 

  • Tarapore, P.E., M.C. Tate, A.M. Findlay, S.M. Honma, D. Mizuiri, M.S. berger, et al. 2012. Preoperative multimodal motor mapping: a comparison of magnetoencephalography imaging, navigated transcranial magnetic stimulation, and direct cortical stimulation. Journal of Neurosurgery 117: 354–362.

    Article  PubMed  PubMed Central  Google Scholar 

  • Trinh, V.T., D.K. Fahim, M.V.C. Maldaun, K. Shah, I.E. McCutcheon, G. Rao, et al. 2014. Impact of preoperative functional magnetic resonance imaging during awake craniotomy procedures for intraoperative guidance and complication avoidance. Stereotactic and Functional Neurosurgery 92: 315–322.

    Article  PubMed  Google Scholar 

  • Tuch, D.S., T.G. Reese, M.R. Wiegell, N. Makris, J.W. Belliveau, and V.J. Wedeen. 2002. High angular resolution diffusion imaging reveals intravoxel white matter fiber heterogeneity. Magnetic Resonance in Medicine 48: 577–582.

    Article  PubMed  Google Scholar 

  • Ulmer, J.L., L. Hacein-Bey, V.P. Mathews, W.M. Mueller, E.A. DeYoe, R.W. Prost, et al. 2004. Lesion-induced pseudo-dominance at functional magnetic resonance imaging: Implications for preoperative assessments. Neurosurgery 55:569–79– discussion 580–1.

    Google Scholar 

  • Vabulas, M., V.A. Kumar, J.D. Hamilton, J.J. Martinez, G. Rao, R. Sawaya, et al. 2014. Real-time atlas-based stereotactic neuronavigation. Neurosurgery 74:128–34– discussion 134.

    Google Scholar 

  • Wedeen, V.J., P. Hagmann, W.-Y.I. Tseng, T.G. Reese, and R.M. Weisskoff. 2005. Mapping complex tissue architecture with diffusion spectrum magnetic resonance imaging. Magnetic Resonance in Medicine 54: 1377–1386.

    Article  PubMed  Google Scholar 

  • Willems, P.W.A., M.J.B. Taphoorn, H. Burger, Berkelbach van der Sprenkel JW, and C.A.F. Tulleken. 2006. Effectiveness of neuronavigation in resecting solitary intracerebral contrast-enhancing tumors: A randomized controlled trial. Journal of Neurosurgery 104: 360–368.

    Article  PubMed  Google Scholar 

  • Wu, J-S., L.-F. Zhou, W.-J. Tang, Y. Mao, J. Hu, Y.-Y. Song, et al. 2007. Clinical evaluation and follow-up outcome of diffusion tensor imaging-based functional neuronavigation: A prospective, controlled study in patients with gliomas involving pyramidal tracts. Neurosurgery 61:935–48– discussion 948–9.

    Google Scholar 

  • Zhu, F.-P., J.-S. Wu, Y.-Y. Song, C.-J. Yao, D.-X. Zhuang, G. Xu, et al. 2012. Clinical application of motor pathway mapping using diffusion tensor imaging tractography and intraoperative direct subcortical stimulation in cerebral glioma surgery: A prospective cohort study. Neurosurgery 71: 1170–1183.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sujit S. Prabhu MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Krivosheya, D., Maldaun, M.V.C., Prabhu, S.S. (2017). Maximal Safe Resection in Glioblastoma: Use of Adjuncts. In: Somasundaram, K. (eds) Advances in Biology and Treatment of Glioblastoma. Current Cancer Research. Springer, Cham. https://doi.org/10.1007/978-3-319-56820-1_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-56820-1_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56819-5

  • Online ISBN: 978-3-319-56820-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics