Hypnosis-Aided Awake Surgery for the Management of Intrinsic Brain Tumors versus Standard Awake-Asleep-Awake Protocol: A Preliminary, Promising Experience

Frati, Alessandro; Pesce, Alessandro; Palmieri, Mauro; Iasanzaniro, Manuela; Familiari, Pietro; Angelini, Albina; Salvati, Maurizio; Rocco, Monica; Raco, Antonino

doi:10.1016/j.wneu.2018.10.004

Cited by 37 publications

(20 citation statements)

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“…At the time of this publication, the last large series of M-GBM collected by Haque et al 40 In our cohort, the survival parameters analysis is disclosed, and a clear cut statistically significant survival disadvantage for patients presenting multifocality concerning unifocal lesions was found, also in consideration of frequent involving of the dominant hemisphere and rolandic cortex [32][33][34][35] for unknown reasons.…”

Section: Discussionmentioning

confidence: 83%

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Standard awake surgery versus hypnosis aided awake surgery for the management of high grade gliomas: A non-randomized cohort comparison controlled trial

Pesce

Palmieri

Cofano

et al. 2020

Journal of Clinical Neuroscience

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Background: Multiple lesion glioblastoma (M-GBM) represent a group of GBM patients in which there exist multiple foci of tumor enhancement. The prognosis is poorer than that of single-lesion GBM patients, but this actually is a controversial data. Is unknown whether multifocality has a genetic and molecular basis. Our specific aim is to identify the molecular characteristics of M-GBM by performing a comprehensive multidimensional analysis.Methods: The surgical, radiological and clinical outcomes of patients that underwent surgery for GBM at our institution for 2 years have been retrospectively reviewed. We compared the overall survival (OS), progression free survival and extent of resection (EOR) between M-GBM tumors (type I) and S-GBM (single contrast-enhancing lesion, type II). Results: A total of 177 patients were included in the final cohort, 12 patients had M-GBM and 165 patients had S-GBM. Although patients with M-GBM had higher tumor volumes and midline location, the EOR was not different between both type of lesions. Higher percentage of tumors with EGFR overexpression was detected in M-GBM. PFS and OS was significantly shorter in M-GBM.

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Section: Discussionmentioning

confidence: 83%

“…white matter appeared free of disease in any aspect of the surgical cavity, 30-32 2. despite a directly visualized or a Navigation proven remnant, neuromonitoring or intraoperative neuropsychological testing outlined a risk for postoperative motor morbidity. [34][35][36]…”

Section: Participants and Eligibilitymentioning

confidence: 99%

Standard awake surgery versus hypnosis aided awake surgery for the management of high grade gliomas: A non-randomized cohort comparison controlled trial

Pesce

Palmieri

Cofano

et al. 2020

Journal of Clinical Neuroscience

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“…This percentage, although higher than reported by most of the authors, however, represents a small proportion of patients affected by this condition [4,6,18]. The poor prognosis is related to several factors, such as the aggressive nature of this disease, which often jeopardizes the feasibility of a real radical surgery, the presence of the blood-brain barrier (BBB) as a natural obstacle to the intracranial penetration of most of the conventional chemotherapeutic agents and the intrinsic refractoriness of GBM with respect to most cytotoxic agents [19][20][21]; Young age, female sex, a high KPS (>70) at diagnosis and Figure 9. The only location associated with a survival reduction was the involvement of the corpus callosum, which, with respect to the remaining locations was significantly associated with a shorter OS (p = 0.061).…”

Section: Discussionmentioning

confidence: 99%

Long Term Survival in Patients Suffering from Glio-blastoma Multiforme: A Single-Center Observational Cohort Study

et al. 2019

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Background: Glioblastomas (GBM) are generally burdened, to date, by a dismal prognosis, although long term survivors have a relatively significant incidence. Our specific aim was to determine the exact impact of many surgery-, patient-and tumor-related variables on survival parameters. Methods: The surgical, radiological and clinical outcomes of patients have been retrospectively reviewed for the present study. All the patients have been operated on in our institution and classified according their overall survival in long term survivors (LTS) and short term survivors (STS). A thorough review of our surgical series was conducted to compare the oncologic results of the patients in regard to: (1) surgical-(2) molecular and (3) treatment-related features. Results: A total of 177 patients were included in the final cohort. Extensive statistical analysis by means of univariate, multivariate and survival analyses disclosed a survival advantage for patients presenting a younger age, a smaller lesion and a better functional status at presentation. From the histochemical point of view, Ki67 (%) was the strongest predictor of better oncologic outcomes. A stepwise analysis of variance outlines the existence of eight prognostic subgroups according to the molecular patterns of Ki67 overexpression and epidermal growth factor receptor (EGFR), p53 and isocitrate dehydrogenase (IDH) mutations. Conclusions: On the grounds of our statistical analyses we can affirm that the following factors were significant predictors of survival advantage: Karnofsky performance status (KPS), age, volume of the lesion, motor disorder at presentation and/or a Ki67 overexpression. In our experience, LTS is associated with a gross total resection (GTR) of tumor correlated with EGFR and p53 mutations with regardless of localization, and poorly correlated to dimension. We suppose that performing a standard molecular analysis (IDH, EGFR, p53 and Ki67) is not sufficient to predict the behavior of a GBM in regards to overall survival (OS), nor to provide a deeper understanding of the meaning of the different genetic alterations in the DNA of cancer cells. A fine molecular profiling is feasible to precisely stratify the prognosis of GBM patients.

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“…This percentage, although higher than reported by the most of the authors, however, represents a small proportion of patients affected by this condition [4,6,10]. The poor prognosis is related to several factors, such as the aggressive nature of this disease, which often jeopardizes the feasibility of a real radical surgery, the presence of the Brain Blood Barrier (BBB) as a natural obstacle to the intracranial penetration of most of the conventional chemotherapeutic agents and the intrinsic refractoriness of GBM in respect of most cytotoxic agents [35,36,37] Temozolomide and Lomustina in two groups of patients, one treated with standard doses, the other with higher doses: the survival improvement was present in both groups (limited to patients with MGMT promoter methylation) and the dose intensification provided additional survival benefit, at price of an increased toxicity [22].…”

Section: Discussionmentioning

confidence: 99%

Long Term Survival in Patients Suffering from Glioblastoma Multiforme: A Single-Centre Observational Cohort Study

Armocida¹,

Pesce²,

Giammarco³

et al. 2019

Preprint

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Background: Glioblastomas (GBM) is generally burdened, to date, by a dismal prognosis, although Long Term Survivors have a relatively significant incidence. Our specific aim was to determine the exact impact of many surgery-, patient- and tumor-related variable on Survival parameters. Methods: The surgical, radiological and clinical outcomes of patients have been retrospectively reviewed for the present study. All the patients have been operated on in our Institution and classified according their Overall Survival in LTS (Long Term Survivors) and STS (Short Term Survivors). A thorough Review of our surgical series was conducted to compare the oncologic results of the patients in regards to 1. Surgical , 2. Molecular, and 3.Treatment related features. Results: A total of 177 patients were included in the final cohort. Extensive statistical analysis by means of univariate, multivariate and survival analyses disclosed a survival advantage for patients presenting a younger age, a smaller lesion and a better functional status at presentation. From the Histochemical point of view, Ki67(%) was the strongest predictor of better oncologic outcomes. A stepwise analysis of variance outlines the existence of 8 prognostic subgroups according to the molecular patterns of Ki67 overexpression and EGFR, p53 and IDH mutations. Conclusions: On the ground of our statistical analyses we can affirm that the following factors were significant predictors of survival advantage: KPS, Age, Volume of the lesion, Motor disorder at presentation, a Ki67 overexpression. A fine molecular profiling is feasible to precisely stratify the prognosis of GBM patients.

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Hypnosis-Aided Awake Surgery for the Management of Intrinsic Brain Tumors versus Standard Awake-Asleep-Awake Protocol: A Preliminary, Promising Experience

Cited by 37 publications

References 35 publications

Standard awake surgery versus hypnosis aided awake surgery for the management of high grade gliomas: A non-randomized cohort comparison controlled trial

Standard awake surgery versus hypnosis aided awake surgery for the management of high grade gliomas: A non-randomized cohort comparison controlled trial

Long Term Survival in Patients Suffering from Glio-blastoma Multiforme: A Single-Center Observational Cohort Study

Long Term Survival in Patients Suffering from Glioblastoma Multiforme: A Single-Centre Observational Cohort Study

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