Supra-complete surgery via dual intraoperative visualization approach (DiVA) prolongs patient survival in glioblastoma
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Ilker Y. Eyüpoglu1, Nirjhar Hore1, Andreas Merkel1, Rolf Buslei2, Michael Buchfelder1, Nicolai Savaskan1
1Department of Neurosurgery, Translational Neurooncology Division, Medical Faculty of The Friedrich Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany
2Department of Neuropathology, Medical Faculty of The Friedrich Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany
Keywords: supra-complete tumor surgery, dual intraoperative visualization approach, supramarginal, 5-ALA, intraoperative MRI
Received: December 21, 2015 Accepted: March 02, 2016 Published: March 25, 2016
Safe and complete resection represents the first step in the treatment of glioblastomas and is mandatory in increasing the effectiveness of adjuvant therapy to prolong overall survival. With gross total resection currently limited in extent to MRI contrast enhancing areas, the extent to which supra-complete resection beyond obvious contrast enhancement could have impact on overall survival remains unclear. DiVA (dual intraoperative visualization approach) redefines gross total resection as currently accepted by enabling for the first time supra-complete surgery without compromising patient safety. This approach exploits the advantages of two already accepted surgical techniques combining intraoperative MRI with integrated functional neuronavigation and 5-ALA by integrating them into a single surgical approach. We investigated whether this technique has impact on overall outcome in GBM patients. 105 patients with GBM were included. We achieved complete resection with intraoperative MRI alone according to current best-practice in glioma surgery in 75 patients. 30 patients received surgery with supra-complete resection. The control arm showed a median life expectancy of 14 months, reflecting current standards-of-care and outcome. In contrast, patients receiving supra-complete surgery displayed significant increase in median survival time to 18.5 months with overall survival time correlating directly with extent of supra-complete resection. This extension of overall survival did not come at the cost of neurological deterioration. We show for the first time that supra-complete glioma surgery leads to significant prolongation of overall survival time in GBM patients.
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