Recurrent high-grade glioma surgery: a multimodal intraoperative protocol to safely increase extent of tumor resection and analysis of its impact on patient outcome

OBJECTIVE No consensus exists on the best treatment for recurrent high-grade glioma (HGG), particularly in terms of surgical indications, and scant data are available integrated use multiple technologies to overcome intraoperative limits pitfalls related artifacts secondary previous surgery radiotherapy. Here, authors report their experience with integration tools HGG surgery, analyzing pros cons as well effectiveness increasing extent tumor resection. In addition, they present a review relevant literature this topic. METHODS The reviewed all cases which had been histologically diagnosed after first patient undergone second involving neuronavigation MRI, CT (iCT), 11 C-methionine–positron emission tomography ( C-MET-PET), 5-aminolevulinic acid (5-ALA) fluorescence, neurophysiological monitoring (IONM), navigated ultrasound (iUS). All were classified according functional grade (1, noneloquent area; 2, near an eloquent 3, area). RESULTS Twenty patients operated using multimodal protocol. was 1 4 patients, 2 8 3 remaining patients. but 100% EOTR obtained. Intraoperative 5-ALA fluorescence iUS showed low specificity sensitivity. iCT detected remnants cases. Postoperatively, 6 (30%) worsening neurological conditions: recovered within 90 days, partially recovered, experienced permanent deficit. median Karnofsky Performance Status remained substantially unchanged over follow-up period. mean progression-free survival 7.7 months (range 2–11 months). overall 25.4 10–52 months), excluding long survivors. Two died 60 days still under at end study. CONCLUSIONS This is study reporting neuronavigation, iUS, iCT, C-MET-PET, IOM during microsurgical resection glioma. believe that proposed protocol useful increase safety, effectiveness, brain alterations radio- chemotherapy.