Meta-analysis of overall survival and postoperative neurologic deficits after resection or biopsy of butterfly glioblastoma

Soliman, Mohamed A.R.; Khan, Asham; Azmy, Shady; Gilbert, Olivia; Khan, Slah; Goliber, Ryan; Szczecinski, Eric J; Durrani, Hamza; Burke, Samantha; Salem, Amany A.; Lubanska, Dorota; Ghannam, Moleca M; Hess, Ryan M.; Lim, Jaims; Mullin, Jeffrey P.; Davies, Jason M.; Pollina, John; Snyder, Kenneth V.; Siddiqui, Adnan H.; Levy, Elad I.; Plunkett, Robert J.; Fenstermaker, Robert A.

doi:10.1007/s10143-022-01864-7

Cited by 8 publications

(4 citation statements)

References 25 publications

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“…These data do not point strongly at SupTR as the reason for reduced adjuvant therapy usage; instead, it suggests that adjuvant therapy is employed when SupTR (and by extension, GTR) is not able to be completed due to concerns regarding potential neurologic morbidity. Permanent postoperative neurological deficits can affect long-term survival [35,[38][39][40], and surgeons will typically prioritize neurologic function over the extent of resection and leave behind tumor that maps to eloquent areas. This indirectly speaks to the feasibility of supratotal resection in that only select patients can be reasonably expected to be candidates for SupTR safely with preserved function.…”

Section: Discussionmentioning

confidence: 99%

“…In the available data, patients who receive SupTR continue working, do not require adjuvant therapy, enjoy reduced seizure burden, and have a good quality of life, similar to or better than patients receiving GTR or STR. One possible conclusion is that SupTR is noninferior to GTR, but there is no evidence to suggest that SupTR should be achieved at the cost of undermining neurological function, echoing the literature detailing supratotal resection of high-grade gliomas [8,11,38,39]. Although a few studies reported improved OS and PFS, the study designs were not proper to assert a difference in these outcome measures and, as such, cannot be used to defend the superiority of this approach.…”

Section: Discussionmentioning

confidence: 99%

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Supratotal Surgical Resection for Low-Grade Glioma: A Systematic Review

Kreatsoulas

Damante

Gruber

et al. 2023

Cancers

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Low-grade gliomas (LGGs) are optimally treated with up-front maximal safe surgical resection, typically defined as maximizing the extent of tumor resection while minimizing neurologic risks of surgery. Supratotal resection of LGG may improve outcomes beyond gross total resection by removing tumor cells invading beyond the tumor border as defined on MRI. However, the evidence regarding supratotal resection of LGG, in terms of impact on clinical outcomes, such as overall survival and neurologic morbidities, remains unclear. Authors independently searched the PubMed, Medline, Ovid, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases for studies evaluating overall survival, time to progression, seizure outcomes, and postoperative neurologic and medical complications of supratotal resection/FLAIRectomy of WHO-defined LGGs. Papers in languages other than English, lacking full-text availability, evaluating supratotal resection of WHO-defined high-grade gliomas only, and nonhuman studies were excluded. After literature search, reference screening, and initial exclusions, 65 studies were screened for relevancy, of which 23 were evaluated via full-text review, and 10 were ultimately included in the final evidence review. Studies were evaluated for quality using the MINORS criteria. After data extraction, a total of 1301 LGG patients were included in the analysis, with 377 (29.0%) undergoing supratotal resection. The main measured outcomes were extent of resection, pre- and postoperative neurological deficits, seizure control, adjuvant treatment, neuropsychological outcomes, ability to return to work, progression-free survival, and overall survival. Overall, low- to moderate-quality evidence was supportive of aggressive, functional boundary-based resection of LGGs due to improvements in progression-free survival and seizure control. The published literature provides a moderate amount of low-quality evidence supporting supratotal surgical resection along functional boundaries for low-grade glioma. Among patients included in this analysis, the occurrence of postoperative neurological deficits was low, and nearly all patients recovered within 3 to 6 months after surgery. Notably, the surgical centers represented in this analysis have significant experience in glioma surgery in general, and supratotal resection specifically. In this setting, supratotal surgical resection along functional boundaries appears to be appropriate for both symptomatic and asymptomatic low-grade glioma patients. Larger clinical studies are needed to better define the role of supratotal resection in LGG.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Supratotal Surgical Resection for Low-Grade Glioma: A Systematic Review

Kreatsoulas

Damante

Gruber

et al. 2023

Cancers

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“…A biopsy is the only other viable alternative for patients with similar lesions [ 7 ]. However, the growing evidence supports improved outcomes with prompt surgical resection.…”

Section: Discussionmentioning

confidence: 99%

Awake minimally invasive parafascicular approach to a language eloquent brain tumour—surgical video

Sangha,

Rajwani,

Price

et al. 2023

Journal of Surgical Case Reports

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Deep-seated brain tumours are surgically challenging to access. When planning approaches to these lesions, it is important to take into account eloquent cortical areas, grey matter nuclei, and subcortical white matter tracts. Traditionally, access to deep-seated lesions would require brain retraction; however, this is associated with secondary brain damage, which may impair neurological function. A trans-sulcal minimally invasive parafascicular approach allows gentle splitting of brain fibres and is thought to splay rather than sever white matter tracts. This is particularly important when approaching medially located, language-eloquent tumours, which lack brain surface expression. This video describes a minimally invasive approach to a deep-seated, language-eloquent brain tumour. We utilized preoperative cortical and subcortical planning to define a safe surgical corridor. We then demonstrate using intraoperative neuro-monitoring and mapping of the motor and language functions to define the boundaries of surgical resection. We find trans-sulcal minimally invasive parafascicular approach to be a safe and effective technique when approaching language-eloquent lesions medial to the main language subcortical networks.

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“…This is a major cause of the high recurrence rate, and the success of the procedure is strongly dependent on the location and accessibility of the tumor mass. Extensive surgical therapy, where possible, is crucial to improve patient prognosis and reduce the risk of recurrence, although this may increase the risk of postoperative neurological deficits [20]. After surgical resection, and if this is not possible, patients receive radiotherapy in combination with chemotherapy, of which Temozolomide (TMZ), a DNA alkylating agent, is the chemotherapy of choice [19].…”

Section: Introductionmentioning

confidence: 99%

Challenges and Promise for Glioblastoma Treatment through Extracellular Vesicle Inquiry

Liguori

2024

Cells

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Glioblastoma (GB) is a rare but extremely aggressive brain tumor that significantly impacts patient outcomes, affecting both duration and quality of life. The protocol established by Stupp and colleagues in 2005, based on radiotherapy and chemotherapy with Temozolomide, following maximum safe surgical resection remains the gold standard for GB treatment; however, it is evident nowadays that the extreme intratumoral and intertumoral heterogeneity, as well as the invasiveness and tendency to recur, of GB are not compatible with a routine and unfortunately ineffective treatment. This review article summarizes the main challenges in the search for new valuable therapies for GB and focuses on the impact that extracellular vesicle (EV) research and exploitation may have in the field. EVs are natural particles delimited by a lipidic bilayer and filled with functional cellular content that are released and uptaken by cells as key means of cell communication. Furthermore, EVs are stable in body fluids and well tolerated by the immune system, and are able to cross physiological, interspecies, and interkingdom barriers and to target specific cells, releasing inherent or externally loaded functionally active molecules. Therefore, EVs have the potential to be ideal allies in the fight against GB and to improve the prognosis for GB patients. The present work describes the main preclinical results obtained so far on the use of EVs for GB treatment, focusing on both the EV sources and molecular cargo used in the various functional studies, primarily in vivo. Finally, a SWOT analysis is performed, highlighting the main advantages and pitfalls of developing EV-based GB therapeutic strategies. The analysis also suggests the main directions to explore to realize the possibility of exploiting EVs for the treatment of GB.

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Meta-analysis of overall survival and postoperative neurologic deficits after resection or biopsy of butterfly glioblastoma

Cited by 8 publications

References 25 publications

Supratotal Surgical Resection for Low-Grade Glioma: A Systematic Review

Supratotal Surgical Resection for Low-Grade Glioma: A Systematic Review

Awake minimally invasive parafascicular approach to a language eloquent brain tumour—surgical video

Challenges and Promise for Glioblastoma Treatment through Extracellular Vesicle Inquiry

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