Astrocytoma surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
Surgical intervention is the mainstay of treatment for astrocytomas. Extensive resection is preferred over partial resection. The relative contraindications of brain surgery are: Advanced age, sever cardiopulmonary dysfunction, inaccessible lesions and sever systemic illness such as sepsis.
Indications
- Surgical intervention is the mainstay of treatment for astrocytomas.
- Some studies suggest the resection of big tumors which are symptomatic or cause intracranial hypertension and monitor the small ones for further growth.
- Other Studies proved that early resection of the tumor at the time of diagnosis can improve patients prognosis.[1][2][3][4][5][6]
Surgery
Low grade astrocytoma
- Extensive resection is preferred over partial resection or biopsy.
- Some types of diffuse astrocytomas which are IDH mutation positive are prone to growth back if small areas of tumor cell remain after surgery.
- Because of infiltrative character of astrocytomas, complete resection may not be possible so we need chemotherapy or radiation for complete treatment.[3][7][8][9][10]
High grade astrocytoma
- The main goal in resection of high-grade astrocytoma is resection all of the tumor and involved brain tissue with minimal neurological damage.
- Many studies demonstrated that extensive resection improves patient’s prognosis.
- In high grade astrocytomas which complete resection is not possible, the preferred areas for resection are contrast enhancing parts of the tumor.[11][12][13][14]
Contraindications
The relative contraindications of brain surgery are:
- Advanced age
- Sever cardiopulmonary dysfunction
- Inaccessible lesions
- Sever systemic illness such as sepsis.[15][16]
References
- ↑ Whittle IR (2010). "What is the place of conservative management for adult supratentorial low-grade glioma?". Adv Tech Stand Neurosurg. 35: 65–79. PMID 20102111.
- ↑ Sanai N, Chang S, Berger MS (November 2011). "Low-grade gliomas in adults". J. Neurosurg. 115 (5): 948–65. doi:10.3171/2011.7.JNS101238. PMID 22043865.
- ↑ 3.0 3.1 Aghi MK, Nahed BV, Sloan AE, Ryken TC, Kalkanis SN, Olson JJ (December 2015). "The role of surgery in the management of patients with diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline". J. Neurooncol. 125 (3): 503–30. doi:10.1007/s11060-015-1867-1. PMID 26530265.
- ↑ Jakola AS, Myrmel KS, Kloster R, Torp SH, Lindal S, Unsgård G, Solheim O (November 2012). "Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas". JAMA. 308 (18): 1881–8. doi:10.1001/jama.2012.12807. PMID 23099483.
- ↑ Jakola AS, Skjulsvik AJ, Myrmel KS, Sjåvik K, Unsgård G, Torp SH, Aaberg K, Berg T, Dai HY, Johnsen K, Kloster R, Solheim O (August 2017). "Surgical resection versus watchful waiting in low-grade gliomas". Ann. Oncol. 28 (8): 1942–1948. doi:10.1093/annonc/mdx230. PMC 5834105. PMID 28475680.
- ↑ Recht LD, Lew R, Smith TW (April 1992). "Suspected low-grade glioma: is deferring treatment safe?". Ann. Neurol. 31 (4): 431–6. doi:10.1002/ana.410310413. PMID 1586143.
- ↑ Keles GE, Lamborn KR, Berger MS (November 2001). "Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome". J. Neurosurg. 95 (5): 735–45. doi:10.3171/jns.2001.95.5.0735. PMID 11702861.
- ↑ Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, Tihan T, Vandenberg S, McDermott MW, Berger MS (March 2008). "Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas". J. Clin. Oncol. 26 (8): 1338–45. doi:10.1200/JCO.2007.13.9337. PMID 18323558.
- ↑ McGirt MJ, Chaichana KL, Attenello FJ, Weingart JD, Than K, Burger PC, Olivi A, Brem H, Quinoñes-Hinojosa A (October 2008). "Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas". Neurosurgery. 63 (4): 700–7, author reply 707–8. doi:10.1227/01.NEU.0000325729.41085.73. PMID 18981880.
- ↑ Wijnenga M, French PJ, Dubbink HJ, Dinjens W, Atmodimedjo PN, Kros JM, Smits M, Gahrmann R, Rutten GJ, Verheul JB, Fleischeuer R, Dirven C, Vincent A, van den Bent MJ (January 2018). "The impact of surgery in molecularly defined low-grade glioma: an integrated clinical, radiological, and molecular analysis". Neuro-oncology. 20 (1): 103–112. doi:10.1093/neuonc/nox176. PMC 5761503. PMID 29016833. Vancouver style error: initials (help)
- ↑ Brown TJ, Brennan MC, Li M, Church EW, Brandmeir NJ, Rakszawski KL, Patel AS, Rizk EB, Suki D, Sawaya R, Glantz M (November 2016). "Association of the Extent of Resection With Survival in Glioblastoma: A Systematic Review and Meta-analysis". JAMA Oncol. 2 (11): 1460–1469. doi:10.1001/jamaoncol.2016.1373. PMID 27310651.
- ↑ Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ (May 2006). "Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial". Lancet Oncol. 7 (5): 392–401. doi:10.1016/S1470-2045(06)70665-9. PMID 16648043.
- ↑ Pichlmeier U, Bink A, Schackert G, Stummer W (December 2008). "Resection and survival in glioblastoma multiforme: an RTOG recursive partitioning analysis of ALA study patients". Neuro-oncology. 10 (6): 1025–34. doi:10.1215/15228517-2008-052. PMC 2719000. PMID 18667747.
- ↑ Chaichana KL, Jusue-Torres I, Navarro-Ramirez R, Raza SM, Pascual-Gallego M, Ibrahim A, Hernandez-Hermann M, Gomez L, Ye X, Weingart JD, Olivi A, Blakeley J, Gallia GL, Lim M, Brem H, Quinones-Hinojosa A (January 2014). "Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma". Neuro-oncology. 16 (1): 113–22. doi:10.1093/neuonc/not137. PMC 3870832. PMID 24285550.
- ↑ Reponen E, Korja M, Niemi T, Silvasti-Lundell M, Hernesniemi J, Tuominen H (September 2015). "Preoperative identification of neurosurgery patients with a high risk of in-hospital complications: a prospective cohort of 418 consecutive elective craniotomy patients". J. Neurosurg. 123 (3): 594–604. doi:10.3171/2014.11.JNS141970. PMID 25932609.
- ↑ Winn, H (2017). Youmans and Winn neurological surgery. Philadelphia, PA: Elsevier. ISBN 0323287824.