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University of Catania

University of Catania. School of Medicine Department of Neurosciences Section of Neurosurgery. State of the art in microsurgery of Brain Gliomas. Vincenzo Albanese. Removal of right cerebral hemisphere for certain tumors with hemiplegia Dandy WE JAMA 90: 823-825, 1928 .

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University of Catania

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  1. University of Catania School of Medicine Department of Neurosciences Section of Neurosurgery State of the art in microsurgeryof BrainGliomas Vincenzo Albanese

  2. Removal of right cerebral hemisphere for certain tumors with hemiplegia Dandy WE JAMA 90: 823-825, 1928 “In the gradual evolution of resections of frontal, temporal and occipital lobes for the cure or attempted cure of invasive and otherwise incurable cerebral tumors, it has been found that the right temporal lobe, either frontal lobe or either occipital lobe (the left posterior to the supramarginal gyrus) could be completely removed without apparent mental impairment”.

  3. Survival in GBM stratified by extent of resection Extent of MST 1-yr 2-yr 5-yr resection (months) Gross total 17 72% 31% 12% Subtotal 11 47% 15% 2% Biopsy 7 23% 2% 0% Barker et al. (UCSF), JNS 1996

  4. Goals of surgery for malignant gliomas • 1. Providing diagnosis • 2. Relieving symptomatic mass effect • 3. Improving or manteining the KPS and QOL • 4. “Setting up” postoperative externally delivered therapies • 5. Prolonging survival through cytoreduction • 6. Applying locally-delivered therapies

  5. Preoperative planning DT - iMR Tractography

  6. SurgeryofBrainGliomas is VascularSurgery

  7. RM – PET Fusion Image guided Open Biopsy in non-enhancing glioma

  8. Evaluation of results Early post-op MRI < 48 h

  9. Intraoperativecontrolofresection

  10. Evaluation of results Be aware of Pseudo-progression Preop 8/8/08 Postop 10/9/08 Postop 21/12/08 Postop 21/03/09

  11. Evaluation of results Be aware of Radionecrosis

  12. 65% GTR 5-ALA vs 36% GTR WL

  13. Highly Integrated Glioma Surgery Image and fluorescence guided and cortical and subcortical mapped surgery

  14. Laser assistedmicrosurgery ofBrainGliomas

  15. “Setting up” postoperative therapies • Resection and TMZ – EORTC 26981 (Stupp) • 2-year survival median survival • +TMZ -TMZ +TMZ -TMZ • GTR 37% 14% 18m 14m • STR 23% 9% 14m 12m • Bx 10% 5% 9m 8m van den Bent et al., Eur J Cancer 2005 [abstr]

  16. “A pessimist sees the difficulty in every opportunity, An optimist sees the opportunity in every difficulty.” Winston Churchill

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