Intraoperative 3D ultrasound–guided resection of diffuse low-grade gliomas: radiological and clinical results

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OBJECTIVE

Extent of resection (EOR) and residual tumor volume are linked to prognosis in low-grade glioma (LGG) and there are various methods for facilitating safe maximal resection in such patients. In this prospective study the authors assess radiological and clinical results in consecutive patients with LGG treated with 3D ultrasound (US)–guided resection under general anesthesia.

METHODS

Consecutive LGGs undergoing primary surgery guided with 3D US between 2008 and 2015 were included. All LGGs were classified according to the WHO 2016 classification system. Pre- and postoperative volumetric assessments were performed, and volumetric results were linked to overall and malignant-free survival. Pre- and postoperative health-related quality of life (HRQoL) was evaluated.

RESULTS

Forty-seven consecutive patients were included. Twenty LGGs (43%) were isocitrate dehydrogenase (IDH)–mutated, 7 (14%) were IDH wild-type, 19 (40%) had both IDH mutation and 1p/19q codeletion, and 1 had IDH mutation and inconclusive 1p/19q status. Median resection grade was 93.4%, with gross-total resection achieved in 14 patients (30%). An additional 24 patients (51%) had small tumor remnants < 10 ml. A more conspicuous tumor border (p = 0.02) and lower University of California San Francisco prognostic score (p = 0.01) were associated with less remnant tumor tissue, and overall survival was significantly better with remnants < 10 ml (p = 0.03). HRQoL was maintained or improved in 86% of patients at 1 month. In both cases with severe permanent deficits, relevant ischemia was present on diffusion-weighted postoperative MRI.

CONCLUSIONS

Three-dimensional US–guided LGG resections under general anesthesia are safe and HRQoL is preserved in most patients. Effectiveness in terms of EOR appears to be consistent with published studies using other advanced neurosurgical tools. Avoiding intraoperative vascular injury is a key factor for achieving good functional outcome.

ABBREVIATIONS DWI = diffusion-weighted imaging; EOR = extent of resection; FISH = fluorescence in situ hybridization; GTR = gross-total resection; HRQoL = health-related quality of life; IDH = isocitrate dehydrogenase; iMRI = intraoperative MRI; IQR = interquartile range; KPS = Karnofsky Performance Scale; LGG = low-grade glioma; MCID = minimal clinically important difference; MFS = malignant-free survival; MPRAGE = magnetization-prepared rapid gradient echo; OR = odds ratio; OS = overall survival; RANO = Response Assessment in Neuro-Oncology; UCSF = University of California San Francisco; US = ultrasound.
Article Information

Contributor Notes

Correspondence Hans Kristian Bø: Nordland Hospital Trust, Bodø, Norway. hans.kr.b@gmail.com.INCLUDE WHEN CITING Published online February 1, 2019; DOI: 10.3171/2018.10.JNS181290.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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