Multimodal integrated approaches in low grade glioma surgery

Abstract Surgical management of Diffuse Low-Grade Gliomas (DLGGs) has radically changed in the last 20 years. Awake surgery (AS) in combination with Direct Electrical Stimulation (DES) and real-time neuropsychological testing (RTNT) permits continuous intraoperative feedback, thus allowing to increa...

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Autores principales:	Tamara Ius, Edoardo Mazzucchi, Barbara Tomasino, Giada Pauletto, Giovanni Sabatino, Giuseppe Maria Della Pepa, Giuseppe La Rocca, Claudio Battistella, Alessandro Olivi, Miran Skrap
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8edd07795b2d4e058502d606bd0186c1
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spelling	oai:doaj.org-article:8edd07795b2d4e058502d606bd0186c12021-12-02T16:57:57ZMultimodal integrated approaches in low grade glioma surgery10.1038/s41598-021-87924-22045-2322https://doaj.org/article/8edd07795b2d4e058502d606bd0186c12021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-87924-2https://doaj.org/toc/2045-2322Abstract Surgical management of Diffuse Low-Grade Gliomas (DLGGs) has radically changed in the last 20 years. Awake surgery (AS) in combination with Direct Electrical Stimulation (DES) and real-time neuropsychological testing (RTNT) permits continuous intraoperative feedback, thus allowing to increase the extent of resection (EOR). The aim of this study was to evaluate the impact of the technological advancements and integration of multidisciplinary techniques on EOR. Two hundred and eighty-eight patients affected by DLGG were enrolled. Cases were stratified according to the surgical protocol that changed over time: 1. DES; 2. DES plus functional MRI/DTI images fused on a NeuroNavigation system; 3. Protocol 2 plus RTNT. Patients belonging to Protocol 1 had a median EOR of 83% (28–100), while those belonging to Protocol 2 and 3 had a median EOR of 88% (34–100) and 98% (50–100) respectively (p = 0.0001). New transient deficits with Protocol 1, 2 and 3 were noted in 38.96%, 34.31% and 31,08% of cases, and permanent deficits in 6.49%, 3.65% and 2.7% respectively. The average follow-up period was 6.8 years. OS was influenced by molecular class (p = 0.028), EOR (p = 0.018) and preoperative tumor growing pattern (p = 0.004). Multimodal surgical approach can provide a safer and wider removal of DLGG with potential subsequent benefits on OS. Further studies are necessary to corroborate our findings.Tamara IusEdoardo MazzucchiBarbara TomasinoGiada PaulettoGiovanni SabatinoGiuseppe Maria Della PepaGiuseppe La RoccaClaudio BattistellaAlessandro OliviMiran SkrapNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Tamara Ius Edoardo Mazzucchi Barbara Tomasino Giada Pauletto Giovanni Sabatino Giuseppe Maria Della Pepa Giuseppe La Rocca Claudio Battistella Alessandro Olivi Miran Skrap Multimodal integrated approaches in low grade glioma surgery
description	Abstract Surgical management of Diffuse Low-Grade Gliomas (DLGGs) has radically changed in the last 20 years. Awake surgery (AS) in combination with Direct Electrical Stimulation (DES) and real-time neuropsychological testing (RTNT) permits continuous intraoperative feedback, thus allowing to increase the extent of resection (EOR). The aim of this study was to evaluate the impact of the technological advancements and integration of multidisciplinary techniques on EOR. Two hundred and eighty-eight patients affected by DLGG were enrolled. Cases were stratified according to the surgical protocol that changed over time: 1. DES; 2. DES plus functional MRI/DTI images fused on a NeuroNavigation system; 3. Protocol 2 plus RTNT. Patients belonging to Protocol 1 had a median EOR of 83% (28–100), while those belonging to Protocol 2 and 3 had a median EOR of 88% (34–100) and 98% (50–100) respectively (p = 0.0001). New transient deficits with Protocol 1, 2 and 3 were noted in 38.96%, 34.31% and 31,08% of cases, and permanent deficits in 6.49%, 3.65% and 2.7% respectively. The average follow-up period was 6.8 years. OS was influenced by molecular class (p = 0.028), EOR (p = 0.018) and preoperative tumor growing pattern (p = 0.004). Multimodal surgical approach can provide a safer and wider removal of DLGG with potential subsequent benefits on OS. Further studies are necessary to corroborate our findings.
format	article
author	Tamara Ius Edoardo Mazzucchi Barbara Tomasino Giada Pauletto Giovanni Sabatino Giuseppe Maria Della Pepa Giuseppe La Rocca Claudio Battistella Alessandro Olivi Miran Skrap
author_facet	Tamara Ius Edoardo Mazzucchi Barbara Tomasino Giada Pauletto Giovanni Sabatino Giuseppe Maria Della Pepa Giuseppe La Rocca Claudio Battistella Alessandro Olivi Miran Skrap
author_sort	Tamara Ius
title	Multimodal integrated approaches in low grade glioma surgery
title_short	Multimodal integrated approaches in low grade glioma surgery
title_full	Multimodal integrated approaches in low grade glioma surgery
title_fullStr	Multimodal integrated approaches in low grade glioma surgery
title_full_unstemmed	Multimodal integrated approaches in low grade glioma surgery
title_sort	multimodal integrated approaches in low grade glioma surgery
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/8edd07795b2d4e058502d606bd0186c1
work_keys_str_mv	AT tamaraius multimodalintegratedapproachesinlowgradegliomasurgery AT edoardomazzucchi multimodalintegratedapproachesinlowgradegliomasurgery AT barbaratomasino multimodalintegratedapproachesinlowgradegliomasurgery AT giadapauletto multimodalintegratedapproachesinlowgradegliomasurgery AT giovannisabatino multimodalintegratedapproachesinlowgradegliomasurgery AT giuseppemariadellapepa multimodalintegratedapproachesinlowgradegliomasurgery AT giuseppelarocca multimodalintegratedapproachesinlowgradegliomasurgery AT claudiobattistella multimodalintegratedapproachesinlowgradegliomasurgery AT alessandroolivi multimodalintegratedapproachesinlowgradegliomasurgery AT miranskrap multimodalintegratedapproachesinlowgradegliomasurgery
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Multimodal integrated approaches in low grade glioma surgery

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