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Sascha Marx and Henry W. S. Schroeder

. 5 The endoscopic approach to colloid cysts has several advantages over microsurgery, such as minimal invasiveness and a reduced complication rate. 3 , 4 However, the major disadvantage of the neuroendoscopic technique in comparison to the microsurgical approach is the lower rate of gross-total resection (GTR). In most of the neuroendoscopic reports dating back to the 1980s and 1990s, only cyst fenestration, content aspiration, and coagulation of the capsule remnant were performed, leading to a high percentage of cyst recurrences. 6–8 A meta-analysis of 1278

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Abraham Noorbakhsh, Jessica A. Tang, Logan P. Marcus, Brandon McCutcheon, David D. Gonda, Craig S. Schallhorn, Mark A. Talamini, David C. Chang, Bob S. Carter and Clark C. Chen

practitioners have strongly advocated against aggressive treatment in the elderly population on the grounds of treatment-related toxicity. 8 Accordingly, studies reveal that elderly patients with glioblastoma are less likely to receive the treatments offered to their younger counterparts. 6 In this context, the study aims to determine the impact of age on neurosurgical treatment of glioblastoma patients. The Surveillance, Epidemiology, and End Results (SEER) registry was used to determine whether patient age influences the frequency that gross-total resection (GTR, as

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Andrew J. Dodgshun, Wirginia J. Maixner, Jordan R. Hansford and Michael J. Sullivan

P ilocytic astrocytomas (PAs) are one of the most common pediatric CNS tumors. Optimal management is resection, and long-term survival is known to be excellent for patients in whom gross-total resection (GTR) is able to be achieved. 1 Recurrence after GTR is uncommon, and reported rates vary between 0% 8 and 29%. 10 Some have advocated no surveillance after GTR, 7 but, in practice, it is likely that MRI scans are being obtained for the reassurance of both the clinician and the patient/patient's family. There have been recent reports suggesting that

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Leland Rogers, Jeanette Pueschel, Robert Spetzler, William Shapiro, Stephen Coons, Terry Thomas and Burton Speiser

, local control is a critical end point for cause-specific survival in patients with ependymomas. Each patient in whom a relapse occurred had at least one component of local failure. The 10-year actuarial cause-specific survival rate was 100% in the GTR-plus-radiotherapy cohort, 92% in the GTR-alone cohort, and 71% in the STR-plus-radiotherapy cohort. Gross-total resection plus radiotherapy was allied with an improved 10-year actuarial cause-specific survival rate in comparison with STR plus radiotherapy (p = 0.015), but there was no significant difference between GTR

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Edward G. Shaw, Brian Berkey, Stephen W. Coons, Dennis Bullard, David Brachman, Jan C. Buckner, Keith J. Stelzer, Geoffrey R. Barger, Paul D. Brown, Mark R. Gilbert and Minesh Mehta

Object

In 1998, the Radiation Therapy Oncology Group initiated a Phase II study of observation for adults < 40 years old with cerebral low-grade glioma who underwent a neurosurgeon-determined gross-total resection (GTR).

Methods

Patient eligibility criteria included the presence of a World Health Organization Grade II astrocytoma, oligodendroglioma, or mixed oligoastrocytoma confirmed histologically; age 18–39 years; Karnofsky Performance Scale score ≥ 60; Neurologic Function Scale score ≤ 3; supratentorial tumor location; neurosurgeon-determined GTR; and pre- and postoperative MR imaging with contrast enhancement available for central review by the principal investigator. Patients were observed following GTR and underwent MR imaging every 6 months. Prognostic factors analyzed for their contribution to patient overall survival, progression-free survival (PFS), and tumor recurrence included age, sex, Karnofsky Performance Scale score, Neurologic Function Scale score, histological type, contrast enhancement on preoperative MR imaging, preoperative tumor diameter, residual disease based on postoperative MR imaging, and baseline Mini-Mental State Examination score.

Results

Between 1998 and 2002, 111 eligible patients were entered into the study. In these 111 patients, the overall survival rates at 2 and 5 years were 99 and 93%, respectively. The PFS rates in these 111 patients at 2 and 5 years were 82 and 48%, respectively. Three prognostic factors predicted significantly poorer PFS in univariate and multivariate analyses: 1) preoperative tumor diameter ≥ 4 cm; 2) astrocytoma/oligoastrocytoma histological type; and 3) residual tumor ≥ 1 cm according to MR imaging. Review of the postoperative MR imaging results revealed that 59% of patients had < 1 cm residual disease (with a subsequent 26% recurrence rate), 32% had 1–2 cm residual disease (with a subsequent 68% recurrence rate), and 9% had > 2 cm residual disease (with a subsequent 89% recurrence rate).

Conclusions

These data suggest that young adult patients with low-grade glioma who undergo a neurosurgeondetermined GTR have a > 50% risk of tumor progression 5-years postoperatively, warranting close follow-up and consideration for adjuvant treatment.

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Robert E. Elliott, Yaron A. Moshel and Jeffrey H. Wisoff

. He underwent STR at another institution and was referred to us 1 year later with an enlarging residual tumor. Preoperative MR images demonstrated a small craniopharyngioma in the suprasellar cistern that was elevating the optic chiasm ( Fig. 2A ). Gross-total resection was confirmed on postoperative MR images ( Fig. 2B ); however, the postoperative CT scan revealed 2 flecks of residual calcification: 0.5-mm intrasellar fleck and a 2-mm fleck in the left side of the suprasellar cistern ( Fig. 2C ). The patient remained asymptomatic but routine images obtained 1 year

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Ricardo J. Komotar, J. Bryan Iorgulescu, Daniel M. S. Raper, Eric C. Holland, Kathryn Beal, Mark H. Bilsky, Cameron W. Brennan, Viviane Tabar, Jonathan H. Sherman, Yoshiya Yamada and Philip H. Gutin

primary resection at our institution, although 5 patients underwent resection of a recurrent tumor, and 1 patient received whole-brain radiotherapy for acute lymphoblastic leukemia 16 years prior to surgery. A diagnosis of atypical meningioma was confirmed by histological examination of operative specimens in conjunction with imaging findings, operative appearance, and medical notes. Outcomes were also noted, including postoperative radiotherapy, recurrence, postrecurrence treatment, and survival. Gross-total resection was determined in all patients by postoperative MRI

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Albert H. Kim, Elizabeth A. Thompson, Lance S. Governale, Catalina Santa, Kevin Cahll, Mark W. Kieran, Susan N. Chi, Nicole J. Ullrich, R. Michael Scott and Liliana C. Goumnerova

prevent clinical symptoms. The literature describing patients who have undergone gross-total resection (GTR) of these low-grade tumors reveals a growing sense that frequent postoperative imaging may be of questionable utility due to the extremely low incidence of recurrence. Long-term rates of recurrence following GTR for juvenile pilocytic astrocytomas (JPAs) of the cerebellum are reported to range from 0 to 14%, and that for gangliogliomas (WHO Grade I) is only 1%. 1 , 2 , 7 , 9 , 10 , 12–15 The GTR of dysembryoplastic neuroepithelial tumors (DNETs) also appears to

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Sacit Bulent Omay, João Paulo Almeida, Yu-Ning Chen, Sathwik R. Shetty, Buqing Liang, Shilei Ni, Vijay K. Anand and Theodore H. Schwartz

into the third ventricle. They may present with hydrocephalus, visual loss, pituitary dysfunction, and diabetes insipidus (DI). Surgical management aims to achieve either gross-total resection (GTR) or subtotal resection (STR), with STR being coupled with adjuvant radiation therapy. The latter strategy has gained some favor in recent years due to reduced morbidity and equivalent progression-free and overall survival, 1 , 35 and there has been recent progress in use of targeted therapies against BRAF-mutated craniopharyngiomas. 3 Nevertheless, surgery is still the

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Tae Hoon Roh, Seok-Gu Kang, Ju Hyung Moon, Kyoung Su Sung, Hun Ho Park, Se Hoon Kim, Eui Hyun Kim, Chang-Ki Hong, Chang-Ok Suh and Jong Hee Chang

criteria for determining whether gross-total resection (GTR) has been performed have been previously determined based on T1-enhanced MRI after surgery. A recent study has shown that additional removal of lesions with high signal intensity identified on T2-FLAIR MRI improves survival. 22 Another study noted the extent of resection based on diffusion tensor imaging (DTI) more accurately predicted the survival of patients. 44 However, it is well known that neoplastic cells of a GBM disperse into areas that appear to be normal on MR images. 26 , 43 Whether the removal of