Combined use of multimodal techniques for the resection of glioblastoma involving corpus callosum

Meng Cui; Hewen Chen; Guochen Sun; Jialin Liu; Meng Zhang; Hepu Lin; Caihong Sun; Xiaodong Ma

doi:10.1007/s00701-021-05008-6

Combined use of multimodal techniques for the resection of glioblastoma involving corpus callosum

Acta Neurochir (Wien). 2022 Mar;164(3):689-702. doi: 10.1007/s00701-021-05008-6. Epub 2021 Oct 12.

Authors

Meng Cui^{1

2}, Hewen Chen^{1

2}, Guochen Sun², Jialin Liu², Meng Zhang^{1

2}, Hepu Lin³, Caihong Sun², Xiaodong Ma^{4

5}

Affiliations

¹ Medical School of Chinese PLA, Beijing, 100853, China.
² Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
³ Department of Neurosurgery, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, 100700, China.
⁴ Medical School of Chinese PLA, Beijing, 100853, China. xiaodongm@hotmail.com.
⁵ Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China. xiaodongm@hotmail.com.

Abstract

Purpose: To compare the multimodal techniques (including neuronavigation, intraoperative MRI [iMRI], and neuromonitoring [IONM]) and conventional approach (only guided by neuronavigation) in removing glioblastoma (GBM) with corpus callosum (CC) involvement (ccGBM), their effectiveness and safety were analyzed and compared.

Methods: Electronic medical records were retrospectively reviewed for ccGBM cases treated in our hospital between January 2016 and July 2020. Patient demographics, tumor characteristics, clinical outcomes, extent of resection (EOR), progression-free survival (PFS), and overall survival (OS) were obtained and compared between the multimodal group (used multimodal techniques) and the conventional group (only used neuronavigation). Both groups only included patients that had maximal safe resection (not biopsy). Postoperative radiochemotherapy was also performed or not. Univariate and multivariate analyses were performed to identify significant prognostic factors and optimal EOR threshold.

Results: Finally 56 cases of the multimodal group and 21 cases of the conventional group were included. The multimodal group achieved a higher median EOR (100% versus 96.1%, P = 0.036) and gross total resection rate (60.7% versus 33.3%, P = 0.032) and a lower rate of permanent motor deficits (5.4% versus 23.8%, P = 0.052) than the conventional approach. The multimodal group had the longer median PFS (10.9 versus 7.0 months, P = 0.023) and OS (16.1 versus 11.6 months, P = 0.044) than the conventional group. Postoperative language and cognitive function were similar between the two groups. In multivariate analysis, a higher EOR, radiotherapy, and longer cycles of temozolomide chemotherapy were positive prognostic factors for survival of ccGBM. An optimal EOR threshold of 92% was found to significantly benefit the PFS (HR = 0.51, P = 0.036) and OS (HR = 0.49, P = 0.025) of ccGBM.

Conclusion: Combined use of multimodal techniques can optimize the safe removal of ccGBM. Aggressive resection of EOR > 92% using multimodal techniques combined with postoperative radiochemotherapy should be suggested for ccGBM.

Keywords: Corpus callosum; Glioblastoma; Intraoperative magnetic resonance; Intraoperative neuromonitoring; Neuronavigation; Survival.

MeSH terms

Brain Neoplasms* / diagnostic imaging
Brain Neoplasms* / surgery
Corpus Callosum / diagnostic imaging
Corpus Callosum / pathology
Corpus Callosum / surgery
Glioblastoma* / diagnostic imaging
Glioblastoma* / surgery
Humans
Magnetic Resonance Imaging / methods
Monitoring, Intraoperative / methods
Neurosurgical Procedures / methods
Retrospective Studies
Treatment Outcome