31 resultados para CRET


Relevância:

10.00% 10.00%

Publicador:

Resumo:

BACKGROUND Complete resection of enhancing tumor as assessed by early (<72 hours) postoperative MRI is regarded as the optimal result in glioblastoma surgery. As yet, there is no consensus on standard procedure if post-operative imaging reveals unintended tumor remnants. OBJECTIVE The current study evaluated the feasibility and safety of an early re-do surgery aimed at completing resections with the aid of 5-ALA fluorescence and neuronavigation after detection of enhancing tumor remnants on post-operative MRI. METHODS From October 2008 to October 2012 a single center institutional protocol offered a second surgery within one week to patients with unintentional incomplete glioblastoma resection. We report on the feasibility of the use 5-ALA fluorescence guidance, the extent of resection (EOR) rates and complications of early re-do surgery. RESULTS Nine of 151 patients (6%) with glioblastoma resections had an unintentional tumor remnant with a volume >0.175 cm(3). 5-ALA guided re-do surgery completed the resection (CRET) in all patients without causing neurological deficits, infections or other complications. Patients who underwent a re-do surgery remained hospitalized between surgeries, resulting in a mean length of hospital stay of 11 days (range 7-15), compared to 9 days for single surgery (range 3-23; p=0.147). CONCLUSION Our early re-do protocol led to complete resection of all enhancing tumor in all cases without any new neurological deficits and thus provides a similar oncological result as intraoperative MRI (iMRI). The repeated use of 5-ALA induced fluorescence, used for identification of small remnants, remains highly sensitive and specific in the setting of re-do surgery. Early re-do surgery is a feasible and safe strategy to complete unintended subtotal resections.

Relevância:

10.00% 10.00%

Publicador:

Resumo:

BACKGROUND The technique of 5-aminolevulinic acid (5-ALA) tumor fluorescence is increasingly used to improve visualization of tumor tissue and thereby to increase the rate of patients with gross total resections. In this study, we measured the resection volumes in patients who underwent 5-ALA-guided surgery for non-eloquent glioblastoma and compared them with the preoperative tumor volume. METHODS We selected 13 patients who had received a complete resection according to intraoperative 5-ALA induced fluorescence and CRET according to post-operative T1 contrast-enhanced MRI. The volumes of pre-operative contrast enhancing tissue, post-operative resection cavity and resected tissue were determined through shift-corrected volumetric analysis. RESULTS The mean resection cavity (29 cm(3)) was marginally smaller than the pre-operative contrast-enhancing tumor (39 cm(3), p = 0.32). However, the mean overall resection volume (84 cm(3)) was significantly larger than the pre-operative contrast-enhancing tumor (39 cm(3), p = 0.0087). This yields a mean volume of resected 5-ALA positive, but radiological non-enhancing tissue of 45 cm(3). The mean calculated rim of resected tissue surpassed pre-operative tumor diameter by 6 mm (range 0-10 mm). CONCLUSIONS Results of the current study imply that (i) the resection cavity underestimates the volume of resected tissue and (ii) 5-ALA complete resections go significantly beyond the volume of pre-operative contrast-enhancing tumor bulk on MRI, indicating that 5-ALA also stains MRI non-enhancing tumor tissue. Use of 5-ALA may thus enable extension of coalescent tumor resection beyond radiologically evident tumor. The impact of this more extended resection method on time to progression and overall survival has not been determined, and potentially puts adjacent and functionally intact tissue at risk.

Relevância:

10.00% 10.00%

Publicador:

Resumo:

OBJECT Resection of glioblastoma adjacent to motor cortex or subcortical motor pathways carries a high risk of both incomplete resection and postoperative motor deficits. Although the strategy of maximum safe resection is widely accepted, the rates of complete resection of enhancing tumor (CRET) and the exact causes for motor deficits (mechanical vs vascular) are not always known. The authors report the results of their concept of combining monopolar mapping and 5-aminolevulinic acid (5-ALA)-guided surgery in patients with glioblastoma adjacent to eloquent tissue. METHODS The authors prospectively studied 72 consecutive patients who underwent 5-ALA-guided surgery for a glioblastoma adjacent to the corticospinal tract (CST; < 10 mm) with continuous dynamic monopolar motor mapping (short-train interstimulus interval 4.0 msec, pulse duration 500 μsec) coupled to an acoustic motor evoked potential (MEP) alarm. The extent of resection was determined based on early (< 48 hours) postoperative MRI findings. Motor function was assessed 1 day after surgery, at discharge, and at 3 months. RESULTS Five patients were excluded because of nonadherence to protocol; thus, 67 patients were evaluated. The lowest motor threshold reached during individual surgery was as follows (motor threshold, number of patients): > 20 mA, n = 8; 11-20 mA, n = 13; 6-10 mA, n = 10; 4-5 mA, n = 13; and 1-3 mA, n = 23. Motor deterioration at postsurgical Day 1 and at discharge occurred in 30% (n = 20) and 10% (n = 7) of patients, respectively. At 3 months, 3 patients (4%) had a persisting postoperative motor deficit, 2 caused by vascular injury and 1 by mechanical injury. The rates of intra- and postoperative seizures were 1% and 0%, respectively. Complete resection of enhancing tumor was achieved in 73% of patients (49/67) despite proximity to the CST. CONCLUSIONS A rather high rate of CRET can be achieved in glioblastomas in motor eloquent areas via a combination of 5-ALA for tumor identification and intraoperative mapping for distinguishing between presumed and actual motor eloquent tissues. Continuous dynamic mapping was found to be a very ergonomic technique that localizes the motor tissue early and reliably.

Relevância:

10.00% 10.00%

Publicador:

Resumo:

Black shale samples of Jurassic to Cretaceous age recovered during the 'Norwegian Shelf Drilling Program' between 1987 and 1991 from Sites 7430/10-U-01 (Barents Sea), 6814/04-U-02 (Norwegian Shelf near the Lofoten) and 6307/07-U-02 (Norwegian Shelf near Trondheim) were analyzed for major and trace elements. These laminated black shales are characterized by high total organic carbon (TOC) and total sulfur (TS) contents as well as by significant enrichments in several redox-sensitive and/or sulfide-forming trace metals (Ag, Bi, Cd, Co, Cr, Cu, Mo, Ni, Re, Sb, Tl, U, V, and Zn). Enrichment factors relative to 'average shale' are comparable to those found in Cenomanian-Turonian boundary event (CTBE) black shales and Mediterranean sapropels. The Re content is high in the studied black shales, with maximum values up to 1221 ng/g. Re/Mo ratios averaging 2.3*10**-3 are close to the seawater value. High trace metal enrichments and Re/Mo ratios close to the seawater value point to a dominantly anoxic and sulfidic water column during black shale formation. Interbeds with higher Re/Mo ratios, especially in high-resolution sampled core sections, point to brief periods of suboxic conditions. Additionally, enhanced Zn concentrations in the black shales from the Barents Sea support the assumption that hydrothermal activity was also high during black shale deposition. Trace metal signatures of black shales at different drill sites on a transect along the Norwegian Shelf are not only influenced by water depth but also by their location in the boreal realm. Metal enrichments are higher in the northern compared to the southern sites. Volgian (=Tithonian 151-144 Ma BP) black shales exhibit elevated trace metal contents in comparison to their Berriasian (144-137 Ma BP) counterparts. This probably reflects a change in the circulation pattern during periods of black shale formation. Therefore different paleoceanographic conditions, probably controlled by climatic change linked to the transgression of the paleo-sealevel and the North Atlantic opening, may have developed from the Volgian to the Berriasian.

Relevância:

10.00% 10.00%

Publicador:

Resumo:

Preliminary results of the biostratigraphic analysis of calcareous nannofossils recovered from Ocean Drilling Program Leg 128, Sites 798 and 799, provide clues to the Quaternary oceanography of the Japan Sea. The distribution of calcareous nannofossils from the Quaternary sediments at Site 798 (903 m water depth) may record the position of an Oceanographic frontal boundary between warm water derived from a branch of the Kuroshio Current as it entered the Japan Sea through the Tsushima Straits to the south, and colder water introduced into the western portion of the Japan Sea derived from the winter chilling of northern Japan Sea surface waters. This Oceanographic front probably oscillated north-south over Site 798 in response to glacial/interglacial cycles, or perhaps to some other climatic event or combination of events unique to the Japan Sea. During the last 1.5 m.y., six major intervals are recognized when the Oceanographic front may have been north of Site 798 separated by five major intervals when the frontal boundary may have been south of the site. These migrations were centered around approximately 0.125, 0.29, 0.56, 0.62, 0.85, 0.91, 0.98, 1.0, 1.11, and 1.5 Ma, which correspond to the boundaries separating nannofossil-rich sediments from barren or nearly barren, low-carbonate intervals. Nannofossil-rich intervals may represent times when the frontal boundary was north of Site 798, and the site was above the CCD. Barren or nearly barren intervals represent times when the frontal boundary may have been south of Site 798 and the CCD was probably higher. The distribution of calcareous nannofossils at Site 799 (2073 m water depth) appears to be controlled more by the depth of the CCD than by any climatic effects. The FOD (first occurrence datum) of Emiliania huxleyi, the LOD (last occurrence datum) of Psuedoemiliania lacunosa, Helicosphaera sellii, Calcidiscus macintyrei (10 ?m), and the FOD and LOD of Reticulofenestra asanoi are recognized from Site 798 cores. The LOD of P. lacunosa is observed in sediments from Site 799. Only in the sediments younger than 1.5 Ma are the nannofossils from Sites 798 and 799 preserved well enough and sufficiently numerous for age dating and paleoceanographic conjecture. In-situ dissolution in older sediments at both sites precludes any dating or paleoenvironmental interpretations.