Dokument: The influence of awake craniotomy and intraoperative neurophysiological monitoring in the overall survival of patients diagnosed with Glioblastoma A single centered retrospective analysis

Titel:	The influence of awake craniotomy and intraoperative neurophysiological monitoring in the overall survival of patients diagnosed with Glioblastoma A single centered retrospective analysis
URL für Lesezeichen:	https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=62575
URN (NBN):	urn:nbn:de:hbz:061-20230510-111658-4
Kollektion:	Dissertationen
Sprache:	Englisch
Dokumententyp:	Wissenschaftliche Abschlussarbeiten » Dissertation
Medientyp:	Text
Autor:	Dr. medic. (RO) Suresh Babu, Marian Preetham [Autor]
Dateien:	[Dateien anzeigen] Adobe PDF [Details] 1,71 MB in einer Datei [ZIP-Datei erzeugen] Dateien vom 04.05.2023 / geändert 04.05.2023
Beitragende:	Prof. Dr. med. Sabel, Michael [Gutachter] Dr. Turowski, Bernd [Gutachter]
Stichwörter:	Glioblastoma, intraoperative neurophysiological monitoring, IONM, awake craniotomy, surgical techniques
Dewey Dezimal-Klassifikation:	600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit
Beschreibungen:	Surgical resection of the tumour is critical to treating glioblastomas. As the surgical settings for operating on glioblastomas have evolved, modern monitoring techniques, such as awake craniotomy and intraoperative neurophysiologic monitoring, have been incorporated. Using these state-of-the-art monitoring techniques, surgeons can operate on eloquent-area tumours without increasing postoperative morbidity. This study aims to analyse retrospectively the progression-free survival (PFS), overall survival (OAS) and post-operative outcomes of patients diagnosed with glioblastoma who underwent surgical resection between 2004 and 2018 in the university hospital of Duesseldorf under different surgical settings. A total of 1010 patients were analysed, 631 of which were considered eligible. Of these, 150 patients underwent a biopsy and were considered to have unresectable tumours. Of the 481 patients who underwent surgery, 160 were operated under general anaesthesia, 71 were operated awake with 60-Hz bipolar stimulation, 145 were operated with intraoperative neuromonitoring (IONM), and 105 were operated with a combination of awake and IONM. We found that the number of biopsies decreased significantly with the incorporation of awake surgeries and intraoperative IONM. However, the extent of resection (EOR) achieved under different operative techniques showed no statistical significance favouring a particular operating setting. The National Institute of Health Stroke Scale (NIHSS), Karnofsky Performance Scale (KPS), progression-free survival and overall survival were analysed for the surgical cohort of 481 patients, as well as those who received adjuvant radio and chemotherapy according to the STUPP- protocol and those with IDH wild-type tumours with adjuvant STUPP therapy. The three-month KPS and NIHSS in patients operated with IONM and with a combination of awake and IONM was better than that of the patients operated without monitoring. PFS and OAS were not influenced by operating technique. Based on the analysis, we observed that the incorporation of surgeries combining awake and IONM did not negatively influence the NIHSS or KPS. Instead, the significant decrease of biopsies suggested that the operability of eloquent tumours has increased considerably since the incorporation of awake and IONM surgeries. Thus, this study showed that using awake and IONM in surgeries increases the possibility of operating eloquent-area tumours without causing significant post-operative surgical morbidity for the patient. Ein entscheidender Aspekt bei der Behandlung von Glioblastomen ist die operative Entfernung des Tumorgewebes. Das operative Vorgehen bei der Behandlung von Glioblastomen hat sich konstant weiterentwickelt, indem neue moderne Monitoringtechniken wie Wachkraniotomie oder intraoperatives neurophysiologisches Monitoring (IONM) entwickelt wurden. Indem diese Monitoringtechniken als Goldstandard eingeführt wurden, ist es möglich geworden, auch Tumore in eloquenten Arealen ohne Steigerung der postoperativen Morbidität zu operieren. Als Ziel dieser Studie wurden retrospektiv das progressionsfreie Überleben (PFS), die Gesamtüberlebenszeit (OAS) und das postoperative Outcome von Patienten mit zwischen 2004 und 2018 am Universitätsklinikum Düsseldorf operierten Glioblastomen betrachtet. Insgesamt wurden 1010 Patienten zwischen 2004 und 2018 analysiert. 631 Patienten konnten eingeschlossen werden, von denen 150 lediglich eine Biopsie erhalten hatten. Patienten, welche lediglich biopsiert worden waren, wurden als inoperabel definiert. Bei den übrigen 481 Patienten wurde der Tumor reseziert. 160 Patienten wurden in Intubationsnarkose, 71 wach mit 60 Hz Stimulation, 145 mit IONM und 105 sowohl wach als auch mit IONM operiert. Seit Einführung moderner Monitoringtechniken ist die Anzahl der Biopsien signifikant zurückgegangen. Der Vergleich des Resektionsgrades (EOR) zeigte keine Signifikanz. Die NIHSS (National Institutes of Health Stroke Scale), der Karnofsky-Index (KPS), die PFS und OAS wurde bei der gesamten operativen Kohorte (481 Patienten), bei Patienten, welche operiert worden und adjuvante Strahlen- und Chemotherapie nach STUPP-Protokoll erhalten hatten, sowie bei Patienten, bei welchen zusätzlich zur Operation und STUPP-Schema immunhistologisch ein IDH Wildtyp festgestellt worden war, analysiert. Patienten, welche mit IONM oder wach/IONM operiert worden waren, hatten im Vergleich zu Patienten ohne Monitoring drei Monate nach Operation sowohl eine besseren NIHSS als auch eine bessere KPS. PFS und OAS wurden durch unterschiedliche Monitoringtechniken nicht beeinflusst. Zusammenfassend können wir feststellen, dass die Einführung von Wachoperationen in Kombination mit IONM keinen negativen Einfluss auf NIHSS oder KPS hat. Anhand des signifikanten Rückgangs von Biopsien sehen wir, dass die Operabilität von Tumoren in eloquenten Gehirnarealen erhöht wurde. Diese Studie zeigt, dass Wachoperationen und IONM das Operieren von Tumoren in eloquenten Arealen ohne signifikant negativen Einfluss auf die postoperative Morbidität möglich macht.
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Dokument erstellt am:	10.05.2023
Dateien geändert am:	10.05.2023
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Datum der Promotion:	27.04.2023