Surgical Technology International
35th Edition
Contains 55 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
456 pages
Nov 2019 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Supratotal Resection of Glioblastoma: Is Less More?
Roberto Altieri, MD, Neurosurgeon, Antonio Melcarne, MD, Neurosurgeon, Alessandro Ducati, MD, Professor of Neurosurgery, Pietro Zeppa, MD, Neurosurgical Resident, Michele Maria Lanotte, MD, Assistant Professor , Neurosurgical Unit, University of Turin, Turin, Italy, Riccardo Soffietti, MD, Assistant Professor of Neuro-oncology, Roberta Rudà, MD, Neuro-oncologist, Federica Franchino, MD, Neuro-oncologist, Alessia Pellerino, MD, Neuro-oncologist , Neuro-Oncological Unit, University of Turin, Turin, Italy, Valentina Tardivo, MD, Neurosurgeon, Giuseppe La Rocca, MD, Neurosurgeon, Francesco Zenga, MD, Neurosurgeon, Diego Garbossa, MD, Assistant Professor of Neurosurgery, Chief, Giovanni Sabatino, MD, Neurosurgeon, Neurosurgical Unit, Mater Olbia Hospital, Olbia, Italy, Alessandro Olivi, MD, Professor of Neurosurgery, Chief , Università Cattolica del "Sacro Cuore", University Hospital "A. Gemelli," Rome, Italy, Cristina Mantovani, MD, Radiation Oncologist, Ilaria Chiovatero, MD, Resident in Radiation Oncology, Stefania Martini, MD, Resident in Radiation Oncology, University of Turin, Turin, Italy, Pasquale Dolce, PhD6, Assistant Professor of Medical Statistics, Department of Public Health, University of Naples Federico II, Naples, Italy, Riccardo Savastano, PhD, Mathematician, University of Salerno, Salerno, Italy
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Background: A relationship between the extent of resection (EOR) and survival has been demonstrated in patients with glioblastomas (GBMs). However, despite gross total resection (GTR) of the enhancing nodule (EN), GBMs usually relapse, generally near the surgical cavity. Objective: The aim of this study was to determine the prognostic role of FLAIR resection of GBMs by analyzing pre- and post-operative MRIs to estimate the EOR of EN, FLAIR-hyperintense regions and total tumor volume (TTV). Methods: Radiologic and clinical outcomes were analyzed retrospectively. Pre- and post-operative EN volume, pre- and postoperative FLAIR volume (POFV), and pre- and postoperative TTV were analyzed. EOR was then calculated for each component. Time-dependent ROC curves and cut-off values for pre- and post-operative volumes and EOR were calculated. A Kaplan-Meier analysis with the log-rank test and Cox regression analysis were then used to analyze progression-free survival (PFS) and overall survival (OS). Results: We did not find any correlation between EOR of FLAIR-altered regions and patient survival. On the other hand, there were statistically significant relationships between the prognosis and both a preoperative EN volume less than 31.35 cm3 (p=0.032) and a postoperative EN volume less than 0.57 cm3 (p=0.015). Moreover, an EOR of EN greater than 96% was significantly associated with the prognosis (p=0.0051 for OS and p=0.022 for PFS). Conclusion: Our retrospective, multi-center study suggests that survival in patients with GBM is not affected by the extent of resection of FLAIR-hyperintense areas.
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A Proposed Intention-to-Treat Anatomical Classification of Spinal Dural Tears
Marcelo Galarza, MD, PhD, Professor, Pedro de la Rosa, MD, Neurosurgeon, Claudio Piqueras, MD, Professor, Javier Morales, MD, Neurosurgeon, Regional Service of Neurosurgery, “Virgen de la Arrixaca” University Hospital, Murcia, Spain, Roberto Gazzeri, MD, Neurosurgeon, San Giovanni–Addolorata Hospital, Rome, Italy, Crhistian Garcia Montoya, MD, Neurosurgeon, University Hospital of Torrevieja, Spain
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To clarify outcomes and develop a novel classification according to CSF fistula in a selective cohort with intraoperative spinal dural tear, we examined 72 consecutive patients who underwent spinal dural repair after microdiscectomy (n=42) or lumbar spinal decompression (n=30). Group 1 consisted of 25 patients with Type I (mild) dural tear who were treated with either tissue-glue-coated collagen sponge or fibrin glue. Group 2 consisted of 26 patients with Type II (moderate) dural tear who were treated with both tissue-glue-coated collagen sponge and fibrin glue. Group 3 consisted of 21 patients with Type III (severe) dural tear who were treated with polypropylene suture along with tissue-glue-coated collagen sponge and/or fibrin glue. Evident postoperative internal or external CSF leak was used to determine the patient’s postoperative result. Postoperative internal or external CSF leak was not evident during a minimum 1-year follow-up in Group 1. In contrast, internal CSF leak was evident in both Groups 2 (n=3) and 3 (n=3) during the same follow-up. No external CSF leak was noted in any of the patients. Three patients underwent re-do spinal surgery for CSF leak repair. Patients in all groups satisfactorily avoided CSF leak. According to the intraoperative findings of a distinct dural tear, patients can be treated adequately with a specific surgical technique.
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Improving the Accuracy of Neuronavigation in Cerebral Cavernous Malformation: A Technical Note on 68 Cases
Giuseppe La Rocca, MD, Giovanni Sabatino, MD, PhD, Fabrizio Pignotti, MD, Mater Olbia Hospital, Olbia, Italy, Giuseppe Maria Della Pepa, MD, Catholic University, Rome, Italy, Alessio Albanese, MD, Anna Acampora, MD, Catholic University, Rome, Italy, Giorgia Antonia Simboli, MD, Alessandro Olivi, MD, Professor of Neurosurgery, Enrico Marchese, MD, Catholic University, Rome, Italy, Roberto Altieri, MD, Neuroscience, University of Turin, Turin, Italy
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Cavernous malformations (CM) are benign, low-flow vascular lesions that account for 5% - 13% of all cerebrovascular malformations. Surgery remains the most important treatment strategy, and many different approaches have been developed. We present here our institutional experience with 68 cases using a transcortical neuronavigation approach with some technical nuances to improve navigation accuracy during resection. The technique and clinical outcomes are discussed, with a specific focus on seizure sequels.
Demographic data were collected, along with information on clinical and seizure characteristics at presentation, localization and size of CM, presence of multiple localizations, evidence of recent CM-related bleeding on MRI, intervention features, postoperative complications, prescription of anti-epileptic drugs at discharge and seizure outcome.
We assume that surgery through a narrow well-defined working corridor would limit brain exposure and manipulation, and hence could significantly affect not only general complications, but also seizure control.
The technique is feasible and associated with relatively low rates of minor and major procedure-related complications. It is also a valid method for surgeons in training since the trajectory is planned preoperatively with a senior consultant and the working corridor always follows the catheter, which directly leads to the cavernoma.
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