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Nader Sanai, Mei-Yin Polley, Michael W. McDermott, Andrew T. Parsa and Mitchel S. Berger

retrospectively conducted by a neurosurgeon in a blinded fashion. Manual segmentation was performed with region-of-interest analysis to measure tumor volumes (in cubic centimeters) on the basis of contrast-enhancing tissue seen on T1-weighted MR imaging. Extent of resection was calculated as follows: (preoperative tumor volume − postoperative tumor volume)/preoperative tumor volume. Determination of volumes was made without consideration of clinical outcome. Statistical Analysis Age, percent EOR, KPS scores, and tumor volumes were analyzed as continuous variables. To

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Matthew J. McGirt, Kaisorn L. Chaichana, Muraya Gathinji, Frank J. Attenello, Khoi Than, Alessandro Olivi, Jon D. Weingart, Henry Brem and Alf redo Quiñones-Hinojosa

extensive resection of these lesions. However, the infiltrative nature of malignant astrocytomas precludes total tumor removal. It therefore remains unclear whether more extensive resection of malignant astrocytomas is associated with prolonged survival. We set out to determine if the extent of resection was associated with survival in our institutional experience with malignant astrocytomas. Methods We retrospectively identified all patients who had undergone resection of malignant astrocytomas (WHO Grade III or IV) 22 at our academic institution from 1996

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Orin Bloch, Seunggu J. Han, Soonmee Cha, Matthew Z. Sun, Manish K. Aghi, Michael W. McDermott, Mitchel S. Berger and Andrew T. Parsa

+ irinotecan 3 (9) 4 (19) 7 (27) 3 (10)  lomustine 0 (0) 0 (0) 0 (0) 2 (7)  other 10 (32) 2 (10) 3 (11) 5 (17) * Values represent numbers of patients (%) unless otherwise indicated. Abbreviation: Recur = Recurrence. The extent of resection for each procedure was retrospectively reviewed by a single, experienced neuroradiologist blinded to clinical information. Volumetric analysis of the contrast-enhancing tumor calculated by the reviewing neuroradiologist was used to assess the EOR. T1-weighted pre- and postcontrast images from the

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Matthew M. Grabowski, Pablo F. Recinos, Amy S. Nowacki, Jason L. Schroeder, Lilyana Angelov, Gene H. Barnett and Michael A. Vogelbaum

, 22 While most within the field of neurooncology agree that maximal resection of the tumor offers the best chance for prolonged survival, the impact of extent of resection (EOR) on survival continues to be a point of discussion. 15 Previous studies have used both CT and MRI to try to determine EOR and its implications for survival in GBM patients. Although there are no definitive prospective studies that have shown that EOR alone alters survival, there is a substantial volume of retrospective literature that has shown that maximizing EOR likely extends time to

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Laura A. Snyder, Andrew B. Wolf, Mark E. Oppenlander, Robert Bina, Jeffrey R. Wilson, Lynn Ashby, David Brachman, Stephen W. Coons, Robert F. Spetzler and Nader Sanai

observations have been reported in not only the hemispheric LGG population, but also within specific anatomical subregions, such as the insula. 30 , 34 Nevertheless, a controversy persists, as other studies have failed to identify a similar association between extent of resection (EOR) and LGG transformation. 17 The biological heterogeneity of LGGs may explain these divergent observations. Within the WHO classification, LGGs (Grades I and II) comprise at least 14 different tumor histologies. 22 Further genetic diversity within each of these subcategories adds additional

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Raphael Meier, Nicole Porz, Urspeter Knecht, Tina Loosli, Philippe Schucht, Jürgen Beck, Johannes Slotboom, Roland Wiest and Mauricio Reyes

for the radical resection of contrast-enhancing tumor (CET) compared with subtotal resection. 5 , 17 Resection of CET is usually quantified by reporting the extent of resection (EOR) or residual tumor volume (RTV). Consequently, both EOR 6 , 16 , 24–26 , 31 , 36 , 40 and RTV 6 , 16 were found to be associated with patient survival, suggesting their roles as prognostic biomarkers. 10 , 11 , 25 This has likewise motivated the use of intraoperative 5-aminolevulinic acid fluorescence and electrophysiological mapping and/or intraoperative MRI–assisted surgery in many

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David S. Xu, Al-Wala Awad, Chad Mehalechko, Jeffrey R. Wilson, Lynn S. Ashby, Stephen W. Coons and Nader Sanai

S eizures are a significant source of morbidity for patients with WHO Grade II gliomas. 9 , 19 Prior studies have demonstrated improved seizure control following resection of low-grade gliomas (LGGs), with several analyses identifying gross-total resection as a significant predictor of seizure freedom. 1 , 3 , 13 , 14 However, achieving complete radiographic resection of a newly diagnosed LGG is uncommon when assessed on the basis of FLAIR MRI. Over the past decade, extent of resection (EOR) studies have reported a complete (i.e., 100%) volumetric resection in

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Mark E. Oppenlander, Andrew B. Wolf, Laura A. Snyder, Robert Bina, Jeffrey R. Wilson, Stephen W. Coons, Lynn S. Ashby, David Brachman, Peter Nakaji, Randall W. Porter, Kris A. Smith, Robert F. Spetzler and Nader Sanai

glioblastoma, particularly in light of recent evidence demonstrating a survival benefit associated with greater extent of resection (EOR). 11 In the largest study to date, volumetric analysis of 500 patients with newly diagnosed glioblastoma suggests that an EOR as low as 78% is associated with improved overall survival. 25 Incremental improvement in overall survival is observed beyond this margin as well, even at the highest intervals of resection. 18 , 25 Taken together, these data emphasize the utility of both subtotal and gross-total resections for patients with newly

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Michael Safaee, Michael C. Oh, Praveen V. Mummaneni, Philip R. Weinstein, Christopher P. Ames, Dean Chou, Mitchel S. Berger, Andrew T. Parsa and Nalin Gupta

relative paucity of spinal cord ependymomas in this age group, long-term outcome data are difficult to obtain. Furthermore, because less than 5% of primary CNS tumors in children occur in the spinal cord or cauda equina, outcome data following spinal cord tumor surgery are particularly limited. 11 The extent of resection for spinal cord ependymomas is an important prognostic factor affecting outcome. 3 , 6 , 8 , 44 The role that other factors may play remains less well understood. For example, tumor location may determine the clinical presentation and may prompt early

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Darryl Lau, Shawn L. Hervey-Jumper, Seunggu J. Han and Mitchel S. Berger

G liomas of WHO Grade II and higher are defined by their diffuse infiltrative nature. It is often technically challenging to discern between tumor and normal brain during surgery, especially at the tumor boundaries where clear margins are absent. 1 , 2 Over the past decade there has been an accumulation of evidence from multiple studies showing that greater extent of resection (EOR) results in improved progression-free survival (PFS) and overall survival (OS) in both low- and high-grade gliomas. 3 , 8 , 12 , 13 , 18 Therefore, there is a general consensus that