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Ramaswamy, V., E. Thompson, and MD Taylor. "C.06 Surgical resection of pediatic posterior fossa tumours in the molecular era." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 43, S2 (2016): S12. http://dx.doi.org/10.1017/cjn.2016.72.
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Background: Aggressive surgical resections of posterior fossa tumours result in tremendous neurological sequelae as a result of damage to the brainstem. As such we sought to re-evaluate the role of aggressive surgical resections in the molecular era. Methods: 820 posterior fossa ependymoma and 787 medulloblastoma were genomically profiled and correlated with pertinent clinical variables. Results: Across 787 medulloblastoma cases, the value of extent of resection was greatly dampened when accounting for molecular subgroup. Near-total resections are equivalent to gross total resections across all four subgroups even when correcting for treatment. The prognostic value of a gross total resection as compared to a subtotal resection (>1.5cm2 residual) was restricted to Group 4 tumours (HR 1.26). Across 820 posterior fossa ependymoma PFA ependymoma was a very high risk group compared to PFB ependymoma, and a subtotal PFA ependymoma conferred an extremely poor prognosis. Gross totally resected PFB ependymoma could be cured with surgery alone. Prognostic nomograms in both medulloblastoma and ependymoma revealed molecular subgroup to be the most important predictor of outcome. Conclusions: The prognostic benefit of EOR for patients with medulloblastoma is marginal after accounting for molecular subgroup affiliation. In both molecular subgroups of posterior fossa ependymoma, gross total resection remains an important predictor of outcome.
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Anaizi, Amjad N., Eric A. Gantwerker, Myles L. Pensak, and Philip V. Theodosopoulos. "Facial Nerve Preservation Surgery for Koos Grade 3 and 4 Vestibular Schwannomas." Neurosurgery 75, no. 6 (2014): 671–77. http://dx.doi.org/10.1227/neu.0000000000000547.
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Abstract Background: Facial nerve preservation surgery for large vestibular schwannomas is a novel strategy for maintaining normal nerve function by allowing residual tumor adherent to this nerve or root-entry zone. Objective: To report, in a retrospective study, outcomes for large Koos grade 3 and 4 vestibular schwannomas. Methods: After surgical treatment for vestibular schwannomas in 52 patients (2004–2013), outcomes included extent of resection, postoperative hearing, and facial nerve function. Extent of resection defined as gross total, near total, or subtotal were 7 (39%), 3 (17%), and 8 (44%) in 18 patients after retrosigmoid approaches, respectively, and 10 (29.5%), 9 (26.5%), and 15 (44%) for 34 patients after translabyrinthine approaches, respectively. Results: Hearing was preserved in 1 (20%) of 5 gross total, 0 of 2 near-total, and 1 (33%) of 3 subtotal resections. Good long-term facial nerve function (House-Brackmann grades of I and II) was achieved in 16 of 17 gross total (94%), 11 of 12 near-total (92%), and 21 of 23 subtotal (91%) resections. Long-term tumor control was 100% for gross total, 92% for near-total, and 83% for subtotal resections. Postoperative radiation therapy was delivered to 9 subtotal resection patients and 1 near-total resection patient. Follow-up averaged 33 months. Conclusion: Our findings support facial nerve preservation surgery in becoming the new standard for acoustic neuroma treatment. Maximizing resection and close postoperative radiographic follow-up enable early identification of tumors that will progress to radiosurgical treatment. This sequential approach can lead to combined optimal facial nerve function and effective tumor control rates.
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DeCou, James M., Marc G. Schlatter, Deanna S. Mitchell, and Randel S. Abrams. "Primary Thoracoscopic Gross Total Resection of Neuroblastoma." Journal of Laparoendoscopic & Advanced Surgical Techniques 15, no. 5 (2005): 470–73. http://dx.doi.org/10.1089/lap.2005.15.470.
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Katsevman, Gennadiy A., Ryan C. Turner, Ogaga Urhie, Joseph L. Voelker, and Sanjay Bhatia. "Utility of sodium fluorescein for achieving resection targets in glioblastoma: increased gross- or near-total resections and prolonged survival." Journal of Neurosurgery 132, no. 3 (2020): 914–20. http://dx.doi.org/10.3171/2018.10.jns181174.
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OBJECTIVEIt is commonly reported that achieving gross-total resection of contrast-enhancing areas in patients with glioblastoma (GBM) improves overall survival. Efforts to achieve an improved resection have included the use of both imaging and pharmacological adjuvants. The authors sought to investigate the role of sodium fluorescein in improving the rates of gross-total resection of GBM and to assess whether patients undergoing resection with fluorescein have improved survival compared to patients undergoing resection without fluorescein.METHODSA retrospective chart review was performed on 57 consecutive patients undergoing 64 surgeries with sodium fluorescein to treat newly diagnosed or recurrent GBMs from May 2014 to June 2017 at a teaching institution. Outcomes were compared to those in patients with GBMs who underwent resection without fluorescein.RESULTSComplete or near-total (≥ 98%) resection was achieved in 73% (47/64) of fluorescein cases. Of 42 cases thought not to be amenable to complete resection, 10 procedures (24%) resulted in gross-total resection and 15 (36%) resulted in near-total resection following the use of sodium fluorescein. No patients developed any local or systemic side effects after fluorescein injection. Patients undergoing resection with sodium fluorescein, compared to the non–fluorescein-treated group, had increased rates of gross- or near-total resection (73% vs 53%, respectively; p < 0.05) as well as improved median survival (78 weeks vs 60 weeks, respectively; p < 0.360).CONCLUSIONSThis study is the largest case series to date demonstrating the beneficial effect of utilizing sodium fluorescein as an adjunct in GBM resection. Sodium fluorescein facilitated resection in cases in which it was employed, including dominant-side resections particularly near speech and motor regions. The cohort of patients in which sodium fluorescein was utilized had statistically significantly increased rates of gross- or near-total resection. Additionally, the fluorescein group demonstrated prolonged median survival, although this was not statistically significant. This work demonstrates the promise of an affordable and easy-to-implement strategy for improving rates of total resection of contrast-enhancing areas in patients with GBM.
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D’Souza, Preston, Erin K. Barr, Seshadri D. Thirumala, Roy Jacob, and Laszlo Nagy. "Pigmented epithelioid melanocytoma: a rare lytic bone lesion involving intradural extension and subtotal resection in a 14-month-old girl." Journal of Neurosurgery: Pediatrics 25, no. 6 (2020): 625–28. http://dx.doi.org/10.3171/2020.1.peds19359.
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Pigmented epithelioid melanocytomas (PEMs) are low-grade, intermediate-type borderline melanocytic tumors with limited metastatic potential. To date, PEMs have been treated via gross-total resections. Postoperative recurrence and mortality are rare. This case highlights a unique presentation of a PEM that involved bone destruction and intradural infiltration, which required a subtotal resection. To the authors’ knowledge, this is the first report of a PEM extending through the dura and necessitating subtotal resection, which is contrary to the standard of care, gross-total resection. Surveillance imaging 10 months after resection remained negative for clinical and radiological recurrence.
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Baik, Seung Hyun, So Yeon Kim, Young Cheol Na, and Jin Mo Cho. "Supratotal Resection of Glioblastoma: Better Survival Outcome than Gross Total Resection." Journal of Personalized Medicine 13, no. 3 (2023): 383. http://dx.doi.org/10.3390/jpm13030383.
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Objective: Supratotal resection (SupTR) of glioblastoma allows for a superior long-term disease control and increases overall survival. On the other hand, aggressive conventional approaches, including gross total resections (GTR), are limited by the impairment risk of adjacent eloquent areas, which may cause severe postoperative functional morbidity. This study aimed to analyze institutional cases with respect to the potential survival benefits of additional resection, including lobectomy, as a paradigm for SupTR in patients of glioblastoma. Methods: Between 2014 and 2018, 15 patients with glioblastoma underwent SupTR (GTR and additional lobectomy) at the authors’ institution. The postoperative Karnofsky performance score (KPS), progression-free survival (PFS), and overall survival (OS) were analyzed for the patients. Results: Patients with SupTR showed significantly prolonged PFS and OS. The median PFS and OS values for the entire study group were 33.5 months (95% confidence intervals (CI): 18.5–57.3 months) and 49.1 months (95% CI: 24.7–86.6 months), respectively. Multivariate analysis revealed that the O6-DNA-methylguanine methyltransferase (MGMT) promoter methylation status was the only predictor for both superior PFS (p = 0.03, OR 5.7, 95% CI 1.0–49.8) and OS (p = 0.04, OR 6.5, 95% CI 1.1–40.2). There was no significant difference between the pre- and postoperative KPS scores. Conclusions: Our results suggest that SupTR with lobectomy allows for a superior PFS and OS without negatively affecting patient performance. However, due to the small number of patients, further studies that include more patients are needed.
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Schucht, Philippe, Jürgen Beck, Janine Abu-Isa, et al. "Gross Total Resection Rates in Contemporary Glioblastoma Surgery." Neurosurgery 71, no. 5 (2012): 927–36. http://dx.doi.org/10.1227/neu.0b013e31826d1e6b.
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Abstract BACKGROUND: Complete resection of contrast-enhancing tumor has been recognized as an important prognostic factor in patients with glioblastoma and is a primary goal of surgery. Various intraoperative technologies have recently been introduced to improve glioma surgery. OBJECTIVE: To evaluate the impact of using 5-aminolevulinic acid and intraoperative mapping and monitoring on the rate of complete resection of enhancing tumor (CRET), gross total resection (GTR), and new neurological deficits as part of an institutional protocol. METHODS: One hundred three consecutive patients underwent resection of glioblastoma from August 2008 to November 2010. Eligibility for CRET was based on the initial magnetic resonance imaging assessed by 2 reviewers. The primary end point was the number of patients with CRET and GTR. Secondary end points were volume of residual contrast-enhancing tissue and new postoperative neurological deficits. RESULTS: Fifty-three patients were eligible for GTR/CRET (n = 43 newly diagnosed glioblastoma, n = 10 recurrent); 13 additional patients received surgery for GTR/CRET-ineligible glioblastoma. GTR was achieved in 96% of patients (n = 51, no residual enhancement &gt; 0.175 cm3); CRET was achieved in 89% (n = 47, no residual enhancement). Postoperatively, 2 patients experienced worsening of preoperative hemianopia, 1 patient had a new mild hemiparesis, and another patient sustained sensory deficits. CONCLUSION: Using 5-aminolevulinic acid imaging and intraoperative mapping/monitoring together leads to a high rate of CRET and an increased rate of GTR compared with the literature without increasing the rate of permanent morbidity. The combination of safety and resection-enhancing intraoperative technologies was likely to be the major drivers for this high rate of CRET/GTR.
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Rodgers, Brian, Aaron Metrailer, Christopher Metz, Seilesh Babu, Dennis Bojrab, and Michael LaRouere. "Acoustic Neuroma Recurrence after Translabyrinthine Gross-Total Resection." Journal of Neurological Surgery Part B: Skull Base 78, S 01 (2017): S1—S156. http://dx.doi.org/10.1055/s-0037-1600544.
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Schneider, Julia R., Amrit K. Chiluwal, Orseola Arapi, Kevin Kwan, and Amir R. Dehdashti. "Near Total Versus Gross Total Resection of Large Vestibular Schwannomas: Facial Nerve Outcome." Operative Neurosurgery 19, no. 4 (2020): 414–21. http://dx.doi.org/10.1093/ons/opaa056.
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Abstract BACKGROUND Large vestibular schwannomas (VSs) with brainstem compression are generally reserved for surgical resection. Surgical aggressiveness must be balanced with morbidity from cranial nerve injury. The purpose of the present investigation is to evaluate the clinical presentation, management modality, and patient outcomes following near total resection (NTR) vs gross total resection (GTR) of large VSs. OBJECTIVE To assess facial nerve outcome differences between GTR and NTR patient cohorts. METHODS Between January 2010 and March 2018, a retrospective chart review was completed to capture patients continuously who had VSs with Hannover grades T4a and T4b. NTR was decided upon intraoperatively. Primary data points were collected, including preoperative symptoms, tumor size, extent of resection, and postoperative neurological outcome. RESULTS A total of 37 patients underwent surgery for treatment of large and giant (grade 4a and 4b) VSs. Facial nerve integrity was preserved in 36 patients (97%) at the completion of surgery. A total of 27 patients underwent complete resection, and 10 had near total (&gt;95%) resection. Among patients with GTR, 78% (21/27) had House-Brackmann (HB) grade I-II facial nerve function at follow-up, whereas 100% (10/10) of the group with NTR had HB grade I-II facial nerve function. Risk of meningitis, cerebrospinal fluid leak, and sinus thromboses were not statistically different between the 2 groups. There was no stroke, brainstem injury, or death. The mean follow-up was 36 mo. CONCLUSION NTR seems to offer a benefit in terms of facial nerve functional outcome compared to GTR in surgical management of large VSs without significant risk of recurrence.
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Li, Yan Michael, Dima Suki, Kenneth Hess, and Raymond Sawaya. "The influence of maximum safe resection of glioblastoma on survival in 1229 patients: Can we do better than gross-total resection?" Journal of Neurosurgery 124, no. 4 (2016): 977–88. http://dx.doi.org/10.3171/2015.5.jns142087.
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OBJECT Glioblastoma multiforme (GBM) is the most common and deadliest primary brain tumor. The value of extent of resection (EOR) in improving survival in patients with GBM has been repeatedly confirmed, with more extensive resections providing added advantages. The authors reviewed the survival of patients with significant EORs and assessed the relative benefit/risk of resecting 100% of the MRI region showing contrast-enhancement with or without additional resection of the surrounding FLAIR abnormality region, and they assessed the relative benefit/risk of performing this additional resection. METHODS The study cohort included 1229 patients with histologically verified GBM in whom ≥ 78% resection was achieved at The University of Texas MD Anderson Cancer Center between June 1993 and December 2012. Patients with > 1 tumor and those 80 years old or older were excluded. The survival of patients having 100% removal of the contrast-enhancing tumor, with or without additional resection of the surrounding FLAIR abnormality region, was compared with that of patients undergoing 78% to < 100% EOR of the enhancing mass. Within the first subgroup, the survival durations of patients with and without resection of the surrounding FLAIR abnormality were subsequently compared. The data on patients and their tumor characteristics were collected prospectively. The incidence of 30-day postoperative complications (overall and neurological) was noted. RESULTS Complete resection of the T1 contrast-enhancing tumor volume was achieved in 876 patients (71%). The median survival time for these patients (15.2 months) was significantly longer than that for patients undergoing less than complete resection (9.8 months; p < 0.001). This survival advantage was achieved without an increase in the risk of overall or neurological postoperative deficits and after correcting for established prognostic factors including age, Karnofsky Performance Scale score, preoperative contrast-enhancing tumor volume, presence of cyst, and prior treatment status (HR 1.53, 95% CI 1.33–1.77, p < 0.001). The effect remained essentially unchanged when data from previously treated and previously untreated groups of patients were analyzed separately. Additional analyses showed that the resection of ≥ 53.21% of the surrounding FLAIR abnormality beyond the 100% contrast-enhancing resection was associated with a significant prolongation of survival compared with that following less extensive resections (median survival times 20.7 and 15.5 months, respectively; p < 0.001). In the multivariate analysis, the previously treated group with < 53.21% resection had significantly shorter survival than the 3 other groups (that is, previously treated patients who underwent FLAIR resection ≥ 53.21%, previously untreated patients who underwent FLAIR resection < 53.21%, and previously untreated patients who underwent FLAIR resection ≥ 53.21%); the previously untreated group with ≥ 53.21% resection had the longest survival. CONCLUSIONS What is believed to be the largest single-center series of GBM patients with extensive tumor resections, this study supports the established association between EOR and survival and presents additional data that pushing the boundary of a conventional 100% resection by the additional removal of a significant portion of the FLAIR abnormality region, when safely feasible, may result in the prolongation of survival without significant increases in overall or neurological postoperative morbidity. Additional supportive evidence is warranted.
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Tosi, Umberto, Marialaura Simonetto, Alexandra Giantini-Larsen, Rohan Ramakrishna, Philip Stieg, and Theodore Schwartz. "RADT-20. POSTOPERATIVE RADIOTHERAPY PROVIDES ADDITIVE PROGRESSION-FREE SURVIVAL BENEFIT IN ATYPICAL MENINGIOMAS REGARDLESS OF EXTENT OF RESECTION." Neuro-Oncology 26, Supplement_8 (2024): viii76. http://dx.doi.org/10.1093/neuonc/noae165.0304.
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Abstract WHO Grade II meningiomas represent a minority of all meningiomas. The creation of treatment algorithms has remained challenging, with the need to add postoperative radiotherapy (RT) following satisfactory gross total resection being oftentimes debated. Thus, the goal of this study was to understand which factors, if any, predispose to recurrence of atypical meningiomas following resection. Therefore, we retrospectively review a 90-patient cohort of WHO grade II meningiomas who underwent surgical resection. Patients were clustered based on tumor location, (convexity or non-convexity) and whether they had received postoperative RT. Following extraction of biographic characteristics, the extent of tumor resection and tumor recurrence were measured. A detailed uni- and multivariate analysis was carried out to determine which factors, if any, predisposed to recurrence. The cohort consisted of 90 patients with a WHO Grade II meningiomas. A gross total resection was achieved in 66.7% of patients. Patients who had a gross total resection and received postoperative RT had longer progression-free survival (p = 0.031) than patients with subtotal resections (STR), regardless of radiation status, and patients with a GTR who did not receive radiation. On uni- and multivariate analysis, receiving postoperative RT was the only factor associated with no recurrence of disease (p = 0.023); no association was found for extent of resection (p = 0.63) or location (p = 0.18). In conclusion, the treatment of WHO grade II meningiomas remains challenging. In this study, we showed how the addition of radiotherapy remains beneficial even in cases of gross total resection, regardless of location. We postulate how microscopic disease not observed on MRI may be responsible for these findings.
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Lekovic, Gregory P., L. Fernando Gonzalez, Iman Feiz-Erfan, and Harold L. Rekate. "Endoscopic Resection of Hypothalamic Hamartoma Using a Novel Variable Aspiration Tissue Resector." Operative Neurosurgery 58, suppl_1 (2006): ONS—166—ONS—169. http://dx.doi.org/10.1227/01.neu.0000193512.87279.69.
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Abstract OBJECTIVE: We present a novel variable aspiration tissue resector for use with neuroendoscopy. METHODS: Two patients, 4 and 14 years old, respectively, presented with intractable gelastic seizures refractory to maximal medical therapies. Magnetic resonance imaging showed mass lesions of the third ventricle consistent with hypothalamic hamartoma. RESULTS: The patients underwent magnetic resonance imaging wand-guided endo-scopic resection of the tumor with the Suros novel variable aspiration tissue resector. There were no device-associated complications or adverse events. The hamartoma was disconnected in one patient, and gross total resection was achieved in the other. CONCLUSION: Endoscopy for tumor resection is still frustrated by the lack of surgical tools, such as ultrasonic aspirators, comparable with those available for use during open procedures. The variable-aspiration tissue resector reported here can be used to resect tumor tissue safely. These two cases demonstrate that gross total resection of small hypothalamic hamartomas is feasible with minimal morbidity through an endo-scopic approach.
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Pollock, Bruce E., and Scott L. Stafford. "Stereotactic Radiosurgery for Recurrent Central Neurocytoma: Case Report." Neurosurgery 48, no. 2 (2001): 441–43. http://dx.doi.org/10.1097/00006123-200102000-00043.
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Abstract OBJECTIVE AND IMPORTANCE Neurocytomas are typically benign tumors that have high local control rates after gross total resection. Nevertheless, tumor recurrence is possible, and some patients have aggressive tumors. CLINICAL PRESENTATION A 26-year-old woman had a recurrent, asymptomatic neurocytoma 3 years after gross total resection. INTERVENTION The patient underwent stereotactic radiosurgery for the tumor recurrence. Thirty-four months later, the patient remained neurologically intact, and the tumor had decreased significantly in size. CONCLUSION Radiosurgery may be a viable treatment option for patients with recurrent neurocytomas or for patients whose tumor resections were subtotal.
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Englot, Dario J., Seunggu J. Han, Mitchel S. Berger, Nicholas M. Barbaro, and Edward F. Chang. "Extent of Surgical Resection Predicts Seizure Freedom in Low-Grade Temporal Lobe Brain Tumors." Neurosurgery 70, no. 4 (2011): 921–28. http://dx.doi.org/10.1227/neu.0b013e31823c3a30.
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Abstract BACKGROUND: Achieving seizure control in patients with low-grade temporal lobe gliomas or glioneuronal tumors remains highly underappreciated, because seizures are the most frequent presenting symptom and significantly impact patient quality-of-life. OBJECTIVE: To assess how the extent of temporal lobe resection influences seizure outcome. METHODS: We performed a quantitative, comprehensive systematic literature review of seizure control outcomes in 1181 patients with epilepsy across 41 studies after surgical resection of low-grade temporal lobe gliomas and glioneuronal tumors. We measured seizure-freedom rates after subtotal resection vs gross-total lesionectomy alone vs tailored resection, including gross-total lesionectomy with hippocampectomy and/or anterior temporal lobe corticectomy. RESULTS: Included studies were observational case series, and no randomized, controlled trials were identified. Although only 43% of patients were seizure-free after subtotal tumor resection, 79% of individuals were seizure-free after gross-total lesionectomy (OR = 5.00, 95% confidence interval [CI]: 3.33-7.14). Furthermore, tailored resection with hippocampectomy plus corticectomy conferred additional benefit over gross-total lesionectomy alone, with 87% of patients achieving seizure freedom (OR = 1.82, 95% CI: 1.23-2.70). Overall, extended resection with hippocampectomy and/or corticectomy over gross-total lesionectomy alone significantly predicted seizure freedom (OR = 1.18, 95% CI: 1.11-1.26). Age &lt;18 years and mesial temporal location also prognosticated favorable seizure outcome. CONCLUSION: Gross-total lesionectomy of low-grade temporal lobe tumors results in significantly improved seizure control over subtotal resection. Additional tailored resection including the hippocampus and/or adjacent cortex may further improve seizure control, suggesting dual pathology may sometimes allow continued seizures after lesional excision.
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Chaulagain, Dipak, Volodymyr Smolanka, Andriy Smolanka, and Taras Havryliv. "Case Report: Impact of gross total resection on survival in glioblastoma." F1000Research 13 (May 17, 2024): 487. http://dx.doi.org/10.12688/f1000research.150065.1.
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Glioblastoma (GBM), known for its aggressive behavior and dismal prognosis. Traditional therapeutic methods, including adjuvant chemotherapy and radiotherapy in conjunction with maximally safe surgical resection, are designed to prolong survival and alleviate symptoms. This case report investigates the relationship between survival outcomes in glioblastoma patients and gross total resection (GTR). A recurring seizure disorder manifested in a 58-year-old female patient presented with left-sided lower limbs weakness and occurred twice weekly for a maximum duration of 20 seconds; this condition necessitated hospitalisation and subsequent surgical intervention. A gross total resection was executed with success, resulting in the accomplishment of complete tumor excision. The patient received radiotherapy after a six-week regimen of temozolomide chemotherapy that followed the surgical removal of tumor. Notably, following treatment, the patient reported a substantial amelioration of symptoms and has maintained a 24-month survival rate thus far, with continuous follow-up. This case highlights the potential for enhanced survival outcomes in the treatment of glioblastoma when gross total resection (GTR) is followed by adjuvant chemo-radiotherapy.
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Ammirati, Mario, Nicholas Vick, Liao Youlian, Ciric Ivan, and Michael Mikhael. "Effect of the Extent of Surgical Resection on Survival and Quality of Life in Patients with Supratentorial Glioblastomas and Anaplastic Astrocytomas." Neurosurgery 21, no. 2 (1987): 201–6. http://dx.doi.org/10.1227/00006123-198708000-00012.
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Abstract Thirty-one patients operated upon for supratentorial glioblastomas or anaplastic astrocytomas were studied to evaluate the effect of the extent of surgical resection on the length and quality of survival. The median age was 50 years and the median preoperative Karnofsky rate was 80. Twenty-one patients (68%) had glioblastoma multiforme, and 10 patients (32%) had anaplastic astrocytoma. Early postoperative enhanced computed tomography was used to determine the extent of tumor resection. Gross total tumor resection was accomplished in 19 patients (61%), and subtotal resection was performed in 12 patients (39%). The two groups were comparable regarding age, sex, pathological condition, preoperative Karnofsky rating, tumor location, postoperative radiation therapy, and postoperative chemotherapy (P &gt; 0.05). The gross total resection group lived longer than the subtotal resection group by life table analysis (P &lt; 0.001; median survival of 90 and 43 weeks, respectively). Postoperatively, the mean functional ability measured by the Karnofsky rating was significantly increased in the gross total resection group (P = 0.006), but not in the subtotal resection group (P &gt; 0.05). The difference in degree of change between preoperative and postoperative Karnofsky rating in the two groups was statistically significant (P = 0.002). The gross total resection group spent significantly more time after the operation in an independent status (Karnofsky rating ≥ 80) compared to the subtotal resection group (P = 0.007; median time of 185 and 12.5 weeks, respectively). Gross total resection of supratentorial glioblastomas and anaplastic astrocytomas is feasible and is directly associated with longer and better survival when compared to subtotal resection.
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Straube, Christoph, Greeshma Elpula, Jens Gempt, et al. "Re-irradiation after gross total resection of recurrent glioblastoma." Strahlentherapie und Onkologie 193, no. 11 (2017): 897–909. http://dx.doi.org/10.1007/s00066-017-1161-6.
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Abrey, Lauren E. "Gross total resection of low-grade glioma in adults." Current Neurology and Neuroscience Reports 9, no. 3 (2009): 181–82. http://dx.doi.org/10.1007/s11910-009-0027-4.
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Irshad, Muhammad, Ch Ali Manzoor, and Muhammad Aamir. "Frequency of gross total resection in intra-axial brain tumors with help of neuronavigation." International Surgery Journal 5, no. 8 (2018): 2712. http://dx.doi.org/10.18203/2349-2902.isj20183006.
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Background: Neuronavigation has become a ubiquitous tool in the surgical management of brain tumors. Neuronavigation is most useful as an adjunct to other brain-mapping techniques such as awake mapping and electrocorticography in the resection of lesions within eloquent motor and language areas. Neuronavigation is also commonly used in skull base tumors, especially for planning an operative trajectory in regions containing vital neurovascular structures and may be used for cerebrovascular surgery. The current study was planned to determine the frequency of gross total resection in intra-axial brain tumors with the help of neuronavigation.Methods: This cross-sectional study was carried out in the Department of Neurosurgery, Nishtar Medical College and Hospital, Multan, from September 2014 to March 2015. After approval from institutional ethical committee, seventy-seven patients fulfilling the inclusion criteria were selected from the patient admitted in the Neurosurgical Department through the Out-Patient Department and patients referred from other departments. After thorough counseling with the patient and his/her relatives, informed consent for procedure was taken.Results: Total 78 patients were included in the study. Out of these 78 (100%), 41 (52.6%) were male and 37 (47.4%) were female. As concern to the outcome variable (gross total resection), out of 78 (100%), in 61 (78.2%) patients gross total resection was present. On cross tabulation it was further clarified that in male patients’ gross total resection present in 32 patients and absent in 9 patients. Similarly, in female patients gross total resection present in 29 patients and absent in 8 patients. P value was 0.747.Conclusions: Conclusion of present study is that neuronavigation is a useful technique in for better gross total resection of intra axial brain tumors.
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Choque-Velasquez, Joham, Julio C. Resendiz-Nieves, Behnam Rezai Jahromi, et al. "Pineocytomas: a long-term follow up study of four cases in Helsinki Neurosurgery." Journal of Case Reports in Medicine 8, no. 1 (2019): 5. http://dx.doi.org/10.25149/case-reports.v8i1.162.
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Background: Pineocytomas are rare benign lesions with a relatively good prognosis if gross total resection can be achieved.
 Report of cases: We present a retrospective review of four patients with histologically confirmed pineocytomas consecutively operated on after 1997. All of our patients were alive at a mean follow-up of 224,5 months (range 204-246). A gross total resection was accomplished in all cases. The cornerstones for the surgical resection of pineocytomas are reported.
 Conclusions: A proper management of pineocytomas, based on the gross total microsurgical resection of the lesion, results in an excellent long term outcome of these pineal lesions.
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Monfared, Ashkan, Carlton E. Corrales, Philip V. Theodosopoulos, et al. "Facial Nerve Outcome and Tumor Control Rate as a Function of Degree of Resection in Treatment of Large Acoustic Neuromas." Neurosurgery 79, no. 2 (2015): 194–203. http://dx.doi.org/10.1227/neu.0000000000001162.
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Abstract BACKGROUND: Patients with large vestibular schwannomas are at high risk of poor facial nerve (cranial nerve VII [CNVII]) function after surgery. Subtotal resection potentially offers better outcome, but may lead to higher tumor regrowth. OBJECTIVE: To assess long-term CNVII function and tumor regrowth in patients with large vestibular schwannomas. METHODS: Prospective multicenter nonrandomized cohort study of patients with vestibular schwannoma ≥2.5 cm who received gross total resection, near total resection, or subtotal resection. Patients received radiation if tumor remnant showed signs of regrowth. RESULTS: Seventy-three patients had adequate follow-up with mean tumor diameter of 3.33 cm. Twelve received gross total resection, 22 near total resection, and 39 subtotal resection. Fourteen (21%) remnant tumors continued to grow, of which 11 received radiation, 1 had repeat surgery, and 2 no treatment. Four of the postradiation remnants (36%) required surgical salvage. Tumor regrowth was related to non-cystic nature, larger residual tumor, and subtotal resection. Regrowth was 3 times as likely with subtotal resection compared to gross total resection and near total resection. Good CNVII function was achieved in 67% immediately and 81% at 1-year. Better immediate nerve function was associated with smaller preoperative tumor size and percentage of tumor left behind on magnetic resonance image. Degree of resection defined by surgeon and preoperative tumor size showed weak trend toward better late CNVII function. CONCLUSION: Likelihood of tumor regrowth was 3 times higher in subtotal resection compared to gross total resection and near total resection groups. Rate of radiation control of growing remnants was suboptimal. Better immediate but not late CNVII outcome was associated with smaller tumors and larger tumor remnants.
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Ciric, Ivan, Mario Ammirati, Nicholas Vick, and Michael Mikhael. "Supratentorial Gliomas: Surgical Considerations and Immediate Postoperative Results Gross Total Resection versus Partial Resection." Neurosurgery 21, no. 1 (1987): 21–26. http://dx.doi.org/10.1227/00006123-198707000-00005.
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Abstract Forty-two patients with supratentorial gliomas not involving the basal ganglia (extraganglionic) were studied pre- and postoperatively with computed tomographic (CT) scans to evaluate the effect of the extent of surgical resection on the immediate postoperative results. Thirty-three patients (79%) had malignant astrocytic gliomas (glioblastoma or anaplastic astrocytoma), 4 patients (10%) had well-differentiated astrocytomas, and 5 (12%) had oligodendrogliomas. The median age was 58 years, and the median Karnofsky rating was 70. There was no operative mortality. Six patients (14%) had surgical complications. A gross total resection was defined as the absence of any abnormal enhancement on the postoperative CT scan. A nearly gross total resection had been accomplished when less than 10% of the preoperatively enhancing mass was still seen. A partial resection was indicated by the presence of more than 10% of the enhancing lesion on the postoperative CT scan. A gross total or nearly gross total resection was accomplished in 36 patients (86%), and an improved or stable postoperative neurological status was present in 35 of these patients (97%). In contrast, the rate of neurological morbidity after a partial resection was 40%. Supratentorial extraganglionic gliomas, regardless of their histological type, generally were well-circumscribed lesions except at the level of the ventricular wall, where glioblastomas and anaplastic astrocytomas blended with the subependymal white matter from which they seemed to arise. (Neurosurgery 21: 21-26, 1987)
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Hoshide, Reid, Harrison Faulkner, Mario Teo, and Charles Teo. "Keyhole retrosigmoid approach for large vestibular schwannomas: strategies to improve outcomes." Neurosurgical Focus 44, no. 3 (2018): E2. http://dx.doi.org/10.3171/2017.11.focus17607.
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OBJECTIVEThere are numerous treatment strategies in the management for large vestibular schwannomas, including resection only, staged resections, resections followed by radiosurgery, and radiosurgery only. Recent evidence has pointed toward maximal resection as being the optimum strategy to prevent tumor recurrence; however, durable tumor control through aggressive resection has been shown to occur at the expense of facial nerve function and to risk other approach-related complications. Through a retrospective analysis of their single-institution series of keyhole neurosurgical approaches for large vestibular schwannomas, the authors aim to report and justify key techniques to maximize tumor resection and reduce surgical morbidity.METHODSA retrospective chart review was performed at the Centre for Minimally Invasive Neurosurgery. All patients who had undergone a keyhole retrosigmoid approach for the resection of large vestibular schwannomas, defined as having a tumor diameter of ≥ 3.0 cm, were included in this review. Patient demographics, preoperative cranial nerve status, perioperative data, and postoperative follow-up were obtained. A review of the literature for resections of large vestibular schwannomas was also performed. The authors’ institutional data were compared with the historical data from the literature.RESULTSBetween 2004 and 2017, 45 patients met the inclusion criteria for this retrospective chart review. When compared with findings in a historical cohort in the literature, the authors’ minimally invasive, keyhole retrosigmoid technique for the resection of large vestibular schwannomas achieved higher rates of gross-total or near-total resection (100% vs 83%). Moreover, these results compare favorably with the literature in facial nerve preservation (House-Brackmann I–II) at follow-up after gross-total resections (81% vs 47%, p < 0.001) and near-total resections (88% vs 75%, p = 0.028). There were no approach-related complications in this series.CONCLUSIONSIt is the experience of the senior author that complete or near-complete resection of large vestibular schwannomas can be successfully achieved via a keyhole approach. In this series of 45 large vestibular schwannomas, a greater extent of resection was achieved while demonstrating high rates of facial nerve preservation and low approach-related and postoperative complications compared with the literature.
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Borger, Valeri, Motaz Hamed, Inja Ilic, et al. "Seizure outcome in temporal glioblastoma surgery: lobectomy as a supratotal resection regime outclasses conventional gross-total resection." Journal of Neuro-Oncology 152, no. 2 (2021): 339–46. http://dx.doi.org/10.1007/s11060-021-03705-x.
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Abstract Introduction The postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery. Recently, supra-total glioblastoma resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma compared to conventional gross-total resections (GTR). However, the impact of ATL on seizure outcome in these patients is unknown. We therefore analyzed ATL and GTR as differing extents of resection in regard of postoperative seizure control in patients with temporal glioblastoma and preoperative symptomatic seizures. Methods Between 2012 and 2018, 33 patients with preoperative seizures underwent GTR or ATL for temporal glioblastoma at the authors’ institution. Seizure outcome was assessed postoperatively and 6 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class 1) versus unfavorable (ILAE class 2–6). Results Overall, 23 out of 33 patients (70%) with preoperative seizures achieved favorable seizure outcome following resection of temporal located glioblastoma. For the ATL group, postoperative seizure freedom was present in 13 out of 13 patients (100%). In comparison, respective rates for the GTR group were 10 out of 20 patients (50%) (p = 0.002; OR 27; 95% CI 1.4–515.9). Conclusions ATL in terms of a supra-total resection strategy was associated with superior favorable seizure outcome following temporal glioblastoma resection compared to GTR. Regarding above mentioned survival benefit following ATL compared to GTR, ATL as an aggressive supra-total resection regime might constitute the surgical modality of choice for temporal-located glioblastoma.
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Gurgel, Richard K., Salim Dogru, Richard L. Amdur, and Ashkan Monfared. "Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?" Neurosurgical Focus 33, no. 3 (2012): E16. http://dx.doi.org/10.3171/2012.7.focus12199.
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Object The object of this study was to evaluate facial nerve outcomes in the surgical treatment of large vestibular schwannomas (VSs; ≥ 2.5 cm maximal or extrameatal cerebellopontine angle diameter) based on both the operative approach and extent of tumor resection. Methods A PubMed search was conducted of English language studies on the treatment of large VSs published from 1985 to 2011. Studies were then evaluated and included if they contained data regarding the size of the tumor, surgical approach, extent of resection, and postoperative facial nerve function. Results Of the 536 studies initially screened, 59 full-text articles were assessed for eligibility, and 30 studies were included for analysis. A total of 1688 tumor resections were reported. Surgical approach was reported in 1390 patients and was significantly associated with facial nerve outcome (ϕ= 0.29, p < 0.0001). Good facial nerve outcomes (House-Brackmann Grade I or II) were produced in 62.5% of the 555 translabyrinthine approaches, 65.2% of the 601 retrosigmoid approaches, and 27.4% of the 234 extended translabyrinthine approaches. Facial nerve outcomes from translabyrinthine and retrosigmoid approaches were not significantly different from each other, but both showed significantly more good facial nerve outcomes, compared with the extended translabyrinthine approach (OR for translabyrinthine vs extended translabyrinthine = 4.43, 95% CI 3.17–6.19, p < 0.0001; OR for retrosigmoid vs extended translabyrinthine = 4.98, 95% CI 3.57–6.95, p < 0.0001). There were 471 patients for whom extent of resection was reported. There was a strong and significant association between degree of resection and outcome (ϕ= 0.38, p < 0.0001). Of the 80 patients receiving subtotal resections, 92.5% had good facial nerve outcomes, compared with 74.6% (n = 55) and 47.3% (n = 336) of those who received near-total resections and gross-total resections, respectively. In the 2-way comparison of good versus suboptimal/poor outcomes (House-Brackmann Grade III–VI), subtotal resection was significantly better than near-total resection (OR = 4.21, 95% CI 1.50–11.79; p = 0.004), and near-total resection was significantly better than gross-total resection (OR = 3.26, 95% CI 1.71–6.20; p = 0.0002) in producing better facial nerve outcomes. Conclusions In a pooled patient population from studies evaluating the treatment of large VSs, subtotal and near-total resections were shown to produce better facial nerve outcomes when compared with gross-total resections. The translabyrinthine and retrosigmoid surgical approaches are likely to result in similar rates of good facial nerve outcomes. Both of these approaches show better facial nerve outcomes when compared with the extended translabyrinthine approach, which is typically reserved for especially large tumors. The reported literature on treatment of large VSs is extremely heterogeneous and minimal consistency in reporting outcomes was observed.
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Rogers, Leland, Jeanette Pueschel, Robert Spetzler, et al. "Is gross-total resection sufficient treatment for posterior fossa ependymomas?" Journal of Neurosurgery 102, no. 4 (2005): 629–36. http://dx.doi.org/10.3171/jns.2005.102.4.0629.
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Object. The goals of this study were to analyze outcomes in patients with posterior fossa ependymomas, determine whether gross-total resection (GTR) alone is appropriate treatment, and evaluate the role of radiation therapy. Methods. All patients with newly diagnosed intracranial ependymomas treated at Barrow Neurological Institute between 1983 and 2002 were identified. Those with supratentorial primary lesions, subependymomas, or neuraxis dissemination were excluded. Forty-five patients met the criteria for the study. Gross-total resection was accomplished in 32 patients (71%) and subtotal resection (STR) in 13 (29%). Radiation therapy was given to 25 patients: 13 following GTR and 12 after STR. The radiation fields were craniospinal followed by a posterior fossa boost in six patients and posterior fossa or local only in the remaining patients. With a median follow-up period of 66 months, the median duration of local control was 73.5 months with GTR alone, but has not yet been reached for patients with both GTR and radiotherapy (p = 0.020). The median duration of local control following STR and radiotherapy was 79.6 months. The 10-year actuarial local control rate was 100% for patients who underwent GTR and radiotherapy, 50% for those who underwent GTR alone, and 36% for those who underwent both STR and radiotherapy, representing significant differences between the GTR-plus-radiotherapy and GTR-alone cohorts (p = 0.018), and between the GTR-plus-radiotherapy and the STR-plus-radiotherapy group (p = 0.003). There was no significant difference in the 10-year actuarial local control rate between the GTR-alone and STR-plus-radiotherapy cohorts (p = 0.370). The 10-year overall survival was numerically superior in patients who underwent both GTR and radiotherapy: 83% compared with 67% in those who underwent GTR alone and 43% in those who underwent both STR and radiotherapy. These differences did not achieve statistical significance. Univariate analyses revealed that radiotherapy, tumor grade, and extent of resection were significant predictors of local control. Conclusions. Gross-total resection should be the intent of surgery when it can be accomplished with an acceptable degree of morbidity. Even after GTR has been confirmed with postoperative imaging, however, adjuvant radiotherapy significantly improves local control. The authors currently recommend the use of postoperative radiotherapy, regardless of whether the resection is gross total or subtotal.
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Kameda, Michelle, Katherine Green, Dana Hutton, et al. "QLTI-02. THE ROLE OF REOPERATION IN PAEDIATRIC PILOCYTIC ASTROCYTOMA." Neuro-Oncology 26, Supplement_8 (2024): viii257. http://dx.doi.org/10.1093/neuonc/noae165.1017.
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Abstract INTRO Cerebellar pilocytic astrocytomas (cPAs) in childhood have long been recognized to have a good prognosis after total resection, but the outcome after incomplete resective surgery remains largely unpredictable, with the incidence of radiological progressive disease ranging from 18-100%. It has been traditionally thought that gross-total resection was required for long-term survival, and small residuals were classically resected in a subsequent operation. OBJECTIVE To determine the role of reoperation in residual or recurrent cerebellar pilocytic astrocytoma. METHODS The authors analyzed their pediatric low-grade clioma (PLGG) database for cases treated between 1985-2020 and filtered for intracranial PAs, to determine what clinical or radiological factors precipitated revisional resective surgery in their single quaternary care center cohort. RESULTS Using the PLGG database, 283 patients &lt;18 years of age were identified to have a histopathological diagnosis or intracranial PA between 1985-2020, of which, 200 were within the cerebellum (70.7%). The majority of patients with cPA were between 1 and 10 years of age (n=145, 72.5%) without gender preponderance (M/F=99:101) usually presenting with 1 lesion (n=197, 98.5%). Gross total resection was achieved in 74.5% (n=149) of initial surgeries for cPA. In patients with subtotal resection, the mean largest diameter of the postoperative residual tumor was 1.06cm (range 0-2.95cm). Seven patients with subtotal resection did not require a second resective intervention. In 31 patients the neuro-oncology multi-disciplinary team recommended a second resection at a mean time interval of 22.9 months (range 0.13-81.6 months) from the initial surgery. Proportionally, the children who underwent multiple resections were also more likely to receive adjuvant chemo/radiotherapy. Functionally, the children in the multiple operation cohort experienced more complications of therapy including ongoing endocrinopathy, treatment-associated hearing deficit, and neuro-cognitive deficits. CONCLUSION Residual disease in cPA should be maintained under clinico-radiological surveillance postoperatively with adoption of a more conservative approach when residual disease is not significantly changing over time.
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Jackson, Christina, John Choi, Carrie Price, et al. "SURG-16. SUPRATOTAL VERSUS GROSS TOTAL RESECTION OF GLIOBLASTOMA: A SYSTEMATIC REVIEW." Neuro-Oncology 21, Supplement_6 (2019): vi243. http://dx.doi.org/10.1093/neuonc/noz175.1017.
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Abstract INTRODUCTION Due to the infiltrative nature of glioblastoma(GBM) outside of the contrast enhancing region in the peritumoral zone, there is increasing movement to perform supratotal resections (SpTR) by extending the edge of resection beyond the contrast enhancing portion of the tumor. However, there is currently no consensus on the potential survival benefit of SpTR in GBM as compared to gross total resection (GTR). METHODS Therefore, we performed a systematic review using PRISMA guidelines and performed a comprehensive literature search on Pubmed, EMBASE, The Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov, from inception to August 16, 2018, to identify articles comparing overall survival (OS) after SpTR versus GTR. Furthermore, we assessed study quality using the Oxford Centre for Evidence-Based Medicine guidelines. RESULTS We identified 8902 unique citations, of which 11 articles and 2 abstracts met study inclusion criteria. 925 patients underwent SpTR out of a total of 2137 patients. 9 of the 13 studies demonstrated improved survival with SpTR compared to GTR (median improvement in OS of 10.5 months), with no significant difference in post-operative complication rate. Conversely, one abstract found worsened outcomes with SpTR compared to GTR (median decrease in OS of 4 months). However, overall study quality was poor, with 12 of the 13 studies of level IV evidence and one study of level IIIb evidence. We were unable to perform a meta-analysis due to significant clinical and methodological heterogeneity amongst the studies (e.g. differences in adjuvant therapy and lack of standardization of definition of supratotal resection). CONCLUSIONS Our systematic review indicates that SpTR may be associated with improved OS compared to GTR for GBM. However, this is limited by poor study quality and significant clinical and methodological heterogeneity amongst the studies. There is need for prospective clinical trials to further establish standardized guidelines for SpTR in GBM.
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Palandri, Giorgio, Thomas Sorenson, Mino Zucchelli, Nicola Acciarri, Paolo Mantovani, and Carmelo Sturiale. "Endoscopic Resection of Hemorrhaged Third Ventricle Cavernous Malformation: 2-Dimensional Operative Video." Operative Neurosurgery 16, no. 2 (2018): E51. http://dx.doi.org/10.1093/ons/opy164.
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Abstract Cavernous malformations of the third ventricle are uncommon vascular lesions. Evidence suggests that cavernous malformations in this location might have a more aggressive natural history due to their risk of intraventricular hemorrhage and hydrocephalus.1 The gold standard of treatment is considered to be microsurgical gross total resection of the lesion. However, with progressive improvement in endoscopic capabilities, several authors have recently advocated for the role of minimally-invasive neuroendoscopy for resecting intraventricular cavernous malformations.2-4 In this timely intraoperative video, we demonstrate the gross total resection of a third ventricle cavernous malformation that presented with hemorrhage via a right-sided trans-frontal neuroendoscopic approach.
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Laurent, Dimitri, Rachel Freedman, Logan Cope, et al. "Impact of Extent of Resection on Incidence of Postoperative Complications in Patients With Glioblastoma." Neurosurgery 86, no. 5 (2019): 625–30. http://dx.doi.org/10.1093/neuros/nyz313.
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Abstract BACKGROUND Extent of resection (EOR) is well established as correlating with overall survival in patients with glioblastoma (GBM). The impact of EOR on reported quality metrics such as patient safety indicators (PSIs) and hospital-acquired conditions (HACs) is unknown. OBJECTIVE To perform a retrospective study to evaluate possible associations between EOR and the incidence of PSIs and HACs. METHODS We queried all patients diagnosed with GBM who underwent surgical resection at our institution between January 2011 and May 2017. Pre- and postoperative magnetic resonance images were analyzed for EOR. Each chart was reviewed to determine the incidence of PSIs and HACs. RESULTS A total of 284 patients met the inclusion criteria. EOR ranged from 39.00 to 100%, with a median of 99.84% and a mean of 95.7%. There were 16 PSI, and 13 HAC, events. There were no significant differences in the rates of PSIs or HACs when compared between patients stratified by gross total resection (EOR ≥ 95%) and subtotal resection (EOR &lt; 95%). The odds of encountering a PSI or HAC were 2.5 times more likely in the subtotal resection group compared to the gross total resection group (P = .58). After adjusting for confounders, the odds of encountering a PSI or HAC in the subtotal resection group were 3.9 times greater than for the gross total resection group (P &lt; .05). CONCLUSION Gross total resection of GBM is associated with a decreased incidence of PSIs and HACs, as compared to subtotal resection.
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Ranger, A., and D. Diosy. "P.124 Meta-analysis comparing predictors of good postoperative seizure control in children with dysembryoplastic neuroepithelial tumors and gangliogliomas." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 43, S2 (2016): S48—S49. http://dx.doi.org/10.1017/cjn.2016.223.
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Background: Dysembryoplastic neuroepithelial tumors (DNETs) and gangliogliomas are the most common cause of tumor-related seizures in children and adolescents. Little is known about predictors of surgical success, in terms of seizure freedom. All relevant papers since 1995 were identified. Methods: Over 4000 abstracts were screened on MedLine to identify data comparing tumor type (DNET vs. ganglioglioma) and predictors of post-operative seizure freedom. Results: Seventeen papers were identified encompassing 97 DNET and 95 ganglioglioma patients. Fifteen patients were found with other neuroglial tumors (NGT) or NGT not-otherwise-specified. DNET patients were found to have less frequent seizures, more likely to have second lobe involvement, and to achieve gross total resection. Seizure freedom was achieved in roughly 80% of patients, with no distinction by tumor type, with no surgery-related or peri-operative deaths. For DNETs, seizure freedom was associated with shorter seizure duration, simple lesionectomy, gross total resection, and shorter duration of follow-up. In ganglioglioma patients, seizure freedom was associated with younger age at surgery, secondary generalization (unexpectedly), absence of dysplasia, and gross total resection. Gross total resection was the strongest predictor. Conclusions: Epilepsy surgery for DNET and ganglioglioma had similar outcomes with gross total resection being the strongest predictor.
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Jang, Hyuk, Yeon Hee Im, Dong-Hyun Kim, Dong-Sup Chung, and Wan-Soo Yoon. "Hurdle of giant pituitary adenoma in achieving total resection." Journal of Korean Skull base society 18, no. 2 (2023): 113–22. http://dx.doi.org/10.55911/jksbs.23.0020.
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Background: Giant pituitary adenoma is a challenging disease in the neurosurgical field. Several therapeutic strategies have been performed depending on tumor characteristics and the surgeon’s experience during the last decades, but it is still difficult to achieve the gross total resection with good clinical outcome. Here, we present our clinical experience with giant pituitary adenomas (PAs) focusing on factors related to surgical outcome.
 Materials and Methods: A total of 26 patients with giant PAs were collected. All clinical data, including preoperative symptom, visual and hormonal function, operation record, and radiologic imaging, were reviewed. Statistical analysis was used to identify the factors related with the extent of resection.
 Results: The median age of patients was 53 years, and all patients showed impaired vision. Endo-scopic transsphenoidal surgery, staged operation, and open craniotomy were performed in 19, 5, and 2 patients, respectively. Fifteen patients received gross total resection, 14 patients received subtotal resection and 1 patient received partial resection. Postoperatively, visual function was improved in 14 patients, not changed in 6, and deteriorated in 4. Gross total resection was significantly related with the tumor size (45 mm), Knosp grade, ICA (internal carotid artery) encasement, and middle cranial fossa extension in the statistical analysis.
 Conclusions: Despite of the limited experience for giant PAs, it still hard to achieve the gross total resection and good clinical outcome. We recommend identifying the tumor characteristics that make it difficult to complete total resection before surgery and consider other strategies, such as staged op-eration or adjuvant radiotherapy.
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Grewal, Maeher R., Daniel B. Spielman, Chetan Safi, et al. "Gross Total Versus Subtotal Surgical Resection in the Management of Craniopharyngiomas." Allergy & Rhinology 11 (January 2020): 215265672096415. http://dx.doi.org/10.1177/2152656720964158.
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Craniopharyngiomas (CP) are suprasellar tumors that can grow into vital nearby structures and thus cause significant visual, endocrine, and hypothalamic dysfunction. Debate persists as to the optimal treatment strategy for these benign lesions, particularly with regards to the extent of surgical resection. The goals of tumor resection are to eliminate the compressive effect of the tumor on surrounding structures and minimize recurrence. It remains unclear whether a gross total resection (GTR) or subtotal resection (STR) with adjuvant therapy confers a better prognosis. Chemotherapy and radiation therapy (RT) have been explored as both neoadjuvant and adjuvant treatments to decrease tumor burden and prevent recurrence. The objective of this paper is to review the risks and benefits of GTR versus STR, specifically with regard to risk of recurrence and postoperative morbidity. Aggregated data suggest that STR monotherapy is associated with higher rates of recurrence relative to GTR (50.6% ± 22.1% vs 20.2% ± 13.5%), while STR combined with RT leads to recurrence rates similar to GTR. However, both GTR and RT are independently associated with higher rates of comorbidities including panhypopituitarism, diabetes insipidus, and visual deficits. The treatment strategy for CPs should ultimately be tailored to each patient’s individual tumor characteristics, risk, symptoms, and therapeutic goals.
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Jun Yoo, Hee, and Jeong Hoon Kim. "NCOG-56. THE NATURAL COURSE OF ATYPICAL MENINGIOMA AFTER GROSS TOTAL RESECTION WITHOUT ADJUVANT TREATMENT." Neuro-Oncology 22, Supplement_2 (2020): ii142. http://dx.doi.org/10.1093/neuonc/noaa215.594.
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Abstract Atypical meningioma represent more aggressive clinical behaviors than WHO grade I meningiomas. In this study, We research natural course of atypical meningioma after gross total resection without adjuvant treatment. MATERIAL AND METHODS: We retrospectively reviewed the records of patients with histopathologically diagnosed atypical meningiomas between June 1990 and December 2015 at Asan Medical Center, Korea. Patients treated with Simpson grade I, II resection were included. Patients variably underwent adjuvant radiation therapy according to each surgeon’s preferences. RESULTS: In this study, 117 patients were enrolled and the average follow-up was 43 months (range 3~228 months). In Simpson grade I tumor resection group, recurrence was confirmed in 10 out of 63 patients without adjuvant treatment, and 1 out of 13 patients with adjuvant radiation treatment. There were 12 recurrence cases in Simpson grade II tumor resection and no adjuvant treatment group, of the total 32 cases. There was 4 recurrence case of total 8 cases of Simpson grade II tumor resection with adjuvant radiation treatment group. In groups with no adjuvant treatment, Simpson grade I resection group had a better prognosis on 5-year PFS (82.9% vs 54.9%, p=0.005) compared to Simpson grade II resection group. DISCUSSION: The results of this study show that there is a significant difference in 5-year PFS between the Simpson grade I and II groups without adjuvant treatment, commonly referred to as the gross total resection group. Although this study report adjuvant RT is not superior to observation, more intensive post-operative imaging surveillance protocols would be considered in Simpson grade II resection group without adjuvant treatment. CONCLUSION: The natural course of atypical meningioma after gross total resection without adjuvant treatment signified Simpson grade I and II resection show significant different prognosis.
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Wadd, Ijaz Hussain, Shahid Mukhtar, Syed Arslan Haider, and Sidra Ijaz. "The Gross Total Resection and Molecular Markers in Grade II Glioma." Pakistan Journal Of Neurological Surgery 25, no. 3 (2021): 348–53. http://dx.doi.org/10.36552/pjns.v25i3.599.
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Objective: The study determined the importance of gross total resection in grade II Glioma and evaluated the importance of tumor markers as prognostic factors.
 Material and Methods: We included the 240 patients aged 13 – 65 years with supratentorialsuspected low-grade Glioma. Craniotomy was done in all my patients under general anesthesia and excised the tumor safely with the help of a microscope and CUSA without causing any focal deficit or hemodynamic instability. The 3D conformal radiotherapy and or Temozolomide chemotherapy was started as advised by the oncologist, postoperatively. The 5 and 10 years’ overall survival and progression-free survival were evaluated in my study.
 Results: Median age of the patients was 45 years. The 46.66% patients were IDH mutant Astrocytoma, 39.1 6% patients were IDH mutant Oligodendroglioma with loss of heterozygosity at I p/l9q levels, and 14.16% patients had IDH wild type Astrocytoma. The gross total resection was done in 113 patients, subtotal in 53 patients, partial resection in 45 patients, and biopsy in 29 patients. Postoperative radiotherapy was done in 170 patients and Temozolomide chemotherapy in 67 patients. The 5 and 10 years’ progression-free survival was 80% and 49% and overall survival was 86.3% and 67%. The 10 – year overall survival for Oligodendroglioma, the IDH mutant Astrocytoma, and IDH wild Astrocytoma were 93%, 61.6%, and 34.7% (respectively), and progression-free survival were 89.2%, 48%, and 34% (respectively). 
 Conclusion: The gross total resection of IDH mutant Astrocytoma had a good outcome.
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Kawaguchi, Tomohiro, Toshihiro Kumabe, Ryuta Saito, et al. "Practical surgical indicators to identify candidates for radical resection of insulo-opercular gliomas." Journal of Neurosurgery 121, no. 5 (2014): 1124–32. http://dx.doi.org/10.3171/2014.7.jns13899.
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Object Maximum resection of gliomas with minimum surgical complications usually leads to optimum outcomes for patients. Radical resection of insulo-opercular gliomas is still challenging, and selection of ideal patients can reduce risk and obtain better outcomes. Methods This retrospective study included 83 consecutively treated patients with newly diagnosed gliomas located at the insulo-opercular region and extending to the sylvian fissure around the primary motor and somatosensory cortices. The authors selected 4 characteristics as surgical indicators: clear tumor boundaries, negative enhancement, intact lenticulostriate arteries, and intact superior extremity of the central insular sulcus. Results Univariate analysis showed that tumors with clear boundaries were associated with higher rates of gross-total resection than were tumors with ambiguous boundaries (75.7% vs 19.6%). Tumors with negative enhancement compared with enhanced tumors were associated with lower frequency of tumor progression (32.0% vs 81.8%, respectively) and lower rates of surgical complications (14.0% vs 45.5%, respectively). Tumors with intact lenticulostriate arteries were associated with higher rates of gross-total resection than were tumors with involved lenticulostriate arteries (67.3% vs 11.8%, respectively). Tumors with intact superior extremity of the central insular sulcus were associated with higher rates of gross-total resection (57.4% vs 20.7%, respectively) and lower rates of surgical complications (18.5% vs 41.4%, respectively) than were tumors with involved anatomical structures. Multivariate analysis showed that clear tumor boundaries were independently associated with gross-total resection (p < 0.001). Negative enhancement was found to be independently associated with surgical complications (p = 0.005), overall survival times (p < 0.001), and progression-free survival times (p = 0.004). Independent associations were also found between intact lenticulostriate arteries and gross-total resection (p < 0.001), between intact lenticulostriate arteries and progression-free survival times (p = 0.026), and between intact superior extremity of the central insular sulcus and gross-total resection (p = 0.043). Among patients in whom all 4 indicators were present, prognosis was good (5-year survival rate 93.3%), resection rate was maximal (gross-total resection 100%), and surgical complication rate was minimal (6.7%). Also among these patients, overall rates of survival (p = 0.003) and progression-free survival (p = 0.005) were significantly higher than among patients in whom fewer indicators were present. Conclusions The authors propose 4 simple indicators that can be used to identify ideal candidates for radical resection of insulo-opercular gliomas, improve the outcomes, and promote maximum resection without introducing neurological complications. The indicators are clear tumor boundaries, negative enhancement, intact lenticulostriate arteries, and intact superior extremity of the central insular sulcus.
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Hardesty, Douglas A., Andrew B. Wolf, David G. Brachman, et al. "The impact of adjuvant stereotactic radiosurgery on atypical meningioma recurrence following aggressive microsurgical resection." Journal of Neurosurgery 119, no. 2 (2013): 475–81. http://dx.doi.org/10.3171/2012.12.jns12414.
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Object Patients with atypical meningioma often undergo gross-total resection (GTR) at initial presentation, but the role of adjuvant radiation therapy remains unclear. The increasing prevalence of stereotactic radiosurgery (SRS) in the modern neurosurgical era has led to the use of routine postoperative radiation therapy in the absence of evidence-based guidelines. This study sought to define the long-term recurrence rate of atypical meningiomas and identify the value of SRS in affecting outcome. Methods The authors identified 228 patients with microsurgically treated atypical meningiomas who underwent a total of 257 resections at the Barrow Neurological Institute over the last 20 years. Atypical meningiomas were diagnosed according to current WHO criteria. Clinical and radiographic data were collected retrospectively. Results Median clinical and radiographic follow-up was 52 months. Gross-total resection, defined as Simpson Grade I or II resection, was achieved in 149 patients (58%). The median proliferative index was 6.9% (range 0.4%–20.6%). Overall 51 patients (22%) demonstrated tumor recurrence at a median of 20.2 months postoperatively. Seventy-one patients (31%) underwent adjuvant radiation postoperatively, with 32 patients (14%) receiving adjuvant SRS and 39 patients (17%) receiving adjuvant intensity modulated radiation therapy (IMRT). The recurrence rate for patients receiving SRS was 25% (8/32) and for IMRT was 18% (7/39), which was not significantly different from the overall group. Gross-total resection was predictive of progression-free survival (PFS; relative risk 0.255, p < 0.0001), but postoperative SRS was not associated with improved PFS in all patients or in only those with subtotal resections. Conclusions Atypical meningiomas are increasingly irradiated, even after complete or near-complete microsurgical resection. This analysis of the largest patient series to date suggests that close observation remains reasonable in the setting of aggressive microsurgical resection. Although postoperative adjuvant SRS did not significantly affect tumor recurrence rates in this experience, a larger cohort study with longer follow-up may reveal a therapeutic benefit in the future.
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Sughrue, Michael E., Rajwant Kaur, Martin J. Rutkowski, et al. "Extent of resection and the long-term durability of vestibular schwannoma surgery." Journal of Neurosurgery 114, no. 5 (2011): 1218–23. http://dx.doi.org/10.3171/2010.11.jns10257.
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Object With limited studies available, the correlation between the extent of resection and tumor recurrence in vestibular schwannomas (VSs) has not been definitively established. In this prospective study, the authors evaluated 772 patients who underwent microsurgical resection of VSs to analyze the association between total tumor resection and the tumor recurrence rate. Methods The authors selected all cases from a prospectively collected database of patients who underwent microsurgical resection as their initial treatment for a histopathologically confirmed VS. Recurrence-free survival was analyzed using Kaplan-Meier analysis. The authors studied the impact of possible confounders such as patient age and tumor size using stepwise Cox regression to calculate the proportional hazard ratio of recurrence while controlling for other cofounding variables. Results The authors analyzed data obtained in 571, 89, and 112 patients in whom gross-total, near-total, and subtotal resections, respectively, were performed. A gross-total resection was achieved in 74% of the patients, and the overall recurrence rate in these patients 8.8%. There was no significant relation between the extent of resection and the rate of tumor recurrence (p = 0.58). As expected, the extent of resection was highly correlated with patient age, tumor size, and surgical approach (p < 0.0001). Using Cox regression, the authors found that the approach used did not significantly affect tumor control when the extent of resection was controlled for. Conclusions While complete tumor removal is ideal, the results presented here suggest that there is no significant relationship between the extent of resection and tumor recurrence.
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Perry, Avital, Christopher S. Graffeo, William R. Copeland, et al. "Microsurgery for Recurrent Vestibular Schwannoma After Previous Gross Total Resection." Otology & Neurotology 38, no. 6 (2017): 882–88. http://dx.doi.org/10.1097/mao.0000000000001402.
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Baskoro, Wisnu, Muhammad Fakhri Raiyan Pratama, Hanan Anwar Rusidi, Adhika Restanto Purnomo, and Bidari Kameswari. "Gross total resection of benign retroperitonealy/intra/paraspinal giant schwannoma." Surgical Neurology International 15 (May 31, 2024): 184. http://dx.doi.org/10.25259/sni_267_2024.
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Background: Schwannoma is a typically benign nerve sheath tumor. Here, a 30-year-old female underwent resection of a benign retroperitoneal/intra/paraspinal schwannoma. Case Description: A 30-year-old female originally had urological surgery to remove an ill-defined retroperitoneal tumor. When she newly presented with right-side low back pain, and the magnetic resonance documented a recurrent/residual L1–L3 intra/paraspinal lesion, she required an additional tumor excision for the removal of the benign schwannoma. Conclusion: Spinal surgeons, dealing with benign schwannomas located in the retroperitoneal/intra/paraspinal compartments, need to work collaboratively with other surgeons (i.e., in this case, urologists) to achieve gross total tumor excision, and the best long-term results.
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Perry, Avital, Christopher Graffeo, William III, et al. "Microsurgery for Recurrent Vestibular Schwannoma after Previous Gross Total Resection." Journal of Neurological Surgery Part B: Skull Base 78, S 01 (2017): S1—S156. http://dx.doi.org/10.1055/s-0037-1600885.
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Rogers, L., J. Pueschel, R. Spetzler, et al. "Is gross total resection sufficient treatment for posterior fossa ependymomas." International Journal of Radiation Oncology*Biology*Physics 54, no. 2 (2002): 205. http://dx.doi.org/10.1016/s0360-3016(02)03410-7.
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Watts, C. "Is Gross-Total Resection Sufficient Treatment for Posterior Fossa Ependymomas?" Yearbook of Neurology and Neurosurgery 2006 (January 2006): 216–17. http://dx.doi.org/10.1016/s0513-5117(08)70377-6.
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Khalafallah, Adham M., Maureen Rakovec, Chetan Bettegowda, et al. "A Crowdsourced Consensus on Supratotal Resection Versus Gross Total Resection for Anatomically Distinct Primary Glioblastoma." Neurosurgery 89, no. 4 (2021): 712–19. http://dx.doi.org/10.1093/neuros/nyab257.
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Abstract BACKGROUND Gross total resection (GTR) of contrast-enhancing tumor is associated with increased survival in primary glioblastoma. Recently, there has been increasing interest in performing supratotal resections (SpTRs) for glioblastoma. OBJECTIVE To address the published results, which have varied in part due to lack of consensus on the definition and appropriate use of SpTR. METHODS A crowdsourcing approach was used to survey 21 neurosurgical oncologists representing 14 health systems nationwide. Participants were presented with 11 definitions of SpTR and asked to rate the appropriateness of each definition. Participants reviewed T1-weighed postcontrast and fluid-attenuated inversion-recovery magnetic resonance imaging for 22 anatomically distinct glioblastomas. Participants were asked to assess the tumor location's eloquence, the perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans. RESULTS Most neurosurgeons surveyed (n = 18, 85.7%) agree that GTR plus resection of some noncontrast enhancement is an appropriate definition for SpTR. Overall, moderate inter-rater agreement existed regarding eloquence, equipoise, and personal treatment plans. The 4 neurosurgeons who had performed &gt;10 SpTRs for glioblastomas in the past year were more likely to recommend it as their treatment plan (P &lt; .005). Cases were divided into 3 anatomically distinct groups based upon perceived eloquence. Anterior temporal and right frontal glioblastomas were considered the best randomization candidates. CONCLUSION We established a consensus definition for SpTR of glioblastoma and identified anatomically distinct locations deemed most amenable to SpTR. These results may be used to plan prospective trials investigating the potential clinical utility of SpTR for glioblastoma.
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Sayyahmelli, Sima, Joseph Roche, and Mustafa Baskaya. "Microsurgical Gross Total Resection of a Large Residual/Recurrent Vestibular Schwannoma via Translabyrinthine Approach." Journal of Neurological Surgery Part B: Skull Base 79, S 05 (2018): S387—S388. http://dx.doi.org/10.1055/s-0038-1669971.
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Although, gross total resection in large vestibular schwannomas is an ideal goal, subtotal resection is frequently performed due to lack of expertise, concerns for facial palsy, or overuse of stereotactic radiation. In this video, we present a 31-year-old man with a 7-year history of tinnitus, dizziness, and hearing loss. The patient had a subtotal resection of a 2.5 cm right-sided vestibular schwannoma via retrosigmoid craniotomy at an outside hospital. He was referred for further surgical resection due to the increased size of the tumor on surveillance magnetic resonance imagings (MRIs) and worsening symptoms. MRI showed a residual/recurrent large schwannoma with extension to the full length of the internal acoustic canal and brain stem compression. He underwent microsurgical gross total resection via a translabyrinthine approach. The facial nerve was preserved and stimulated with 0.15 mA at the brainstem entry zone. He awoke with House–Brackmann grade III facial function, with an otherwise uneventful postoperative course. In this video, microsurgical techniques and important resection steps for this residual/recurrent vestibular schwannoma are demonstrated, and nuances for microsurgical technique are discussed.The link to the video can be found at: https://youtu.be/a0ZxE41Tqzw.
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Tanaka, Kazuhiro, Hiroaki Nagashima, Shunsuke Yamanishi, Yoshihiro Muragaki, and Takashi Sasayama. "SURG-29. EXTENDED RESECTION IMPROVES PATIENT SURVIVAL OUTCOMES AFTER GROSS-TOTAL RESECTION OF GLIOBLASTOMA." Neuro-Oncology 26, Supplement_8 (2024): viii280. http://dx.doi.org/10.1093/neuonc/noae165.1109.
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Abstract In recent years, the effectiveness of extended resection (ER) beyond the contrast-enhanced (CE) lesion has been reported as a surgical strategy for glioblastoma. This study was to determine whether ER of FLAIR-hyperintense area beyond the CE tumor affected the overall survival (OS) and progression-free survival (PFS) of patients with glioblastoma after gross-total resection (GTR). From October 2019 to March 2022, a total of 62 patients who underwent resection of glioblastoma (GBM) at Kobe University Hospital were retrospectively examined. Volumetric measurements of the CE area and surrounding FLAIR-hyperintense area were performed, and clinical variables related with OS and PFS were analyzed. In total, 33 patients with GBM who underwent GTR of the CE tumor met the inclusion criteria. The mean volume of CE tumor and FLAIR hyperintensity area before resection was 36.5 cm3 and 77.2 cm3 respectively. The mean excision rate of FLAIR-hyperintense area was 18.2%. Removal rates of 20% or more in the FLAIR-hyperintense region significantly increased OS and PFS (p=0.040 and 0.026, respectively). In multivariate analysis, age ≥ 65 years (HR 2.73; 95% CI 1.09–7.22; p=0.032) were associated with shorter OS, but ER ≥ 20% (HR 0.41; 95% CI 0.17–0.99; p=0.049) and MGMT promotor methylation (HR 0.36; 95% CI 0.15–0.85; p=0.020) were associated with longer OS. ER of FLAIR-hyperintense lesions of 20% or more in glioblastoma contributed to prolonging patient survival. It is necessary to validate the effect of ER in prospective clinical trials.
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Olszewski, Adam M., Bruce I. Tranmer, and Brandon D. Liebelt. "Contralateral interhemispheric transfalcine approach to precuneal glioblastoma: fluorescein guided microsurgical resection and endoscopic microinspection tool." Neurosurgical Focus: Video 6, no. 1 (2022): V11. http://dx.doi.org/10.3171/2021.10.focvid21195.
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Maximum safe resection remains a primary goal in the treatment of glioblastoma, with gross-total resection conveying additional survival benefit. Multiple intraoperative visualization techniques have been developed to improve the extent of resection. Herein, the authors describe the use of fluorescein and endoscopic assistance with a novel microinspection device in achieving a gross-total resection of a deep seated precuneal glioblastoma. An interhemispheric transfalcine approach was utilized and microsurgical resection was completed with fluorescein guidance. A 45° endoscope was then used to inspect the resection bed, and remaining areas of concern were then resected under endoscopic visualization. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21195
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Esquenazi, Yoshua, Elliott Friedman, Zheyu Liu, Jay-Jiguang Zhu, Sigmund Hsu, and Nitin Tandon. "The Survival Advantage of “Supratotal” Resection of Glioblastoma Using Selective Cortical Mapping and the Subpial Technique." Neurosurgery 81, no. 2 (2017): 275–88. http://dx.doi.org/10.1093/neuros/nyw174.
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Abstract BACKGROUND: A substantial body of evidence suggests that cytoreductive surgery is a prerequisite to prolonging survival in patients with glioblastoma (GBM). OBJECTIVE: To evaluate the safety and impact of “supratotal” resections beyond the zone of enhancement seen on magnetic resonance imaging scans, using a subpial technique. METHODS: We retrospectively evaluated 86 consecutive patients with primary GBM, managed by the senior author, using a subpial resection technique with or without carmustine (BCNU) wafer implantation. Multivariate Cox proportional hazards regression was used to analyze clinical, radiological, and outcome variables. Overall impacts of extent of resection (EOR) and BCNU wafer placement were compared using Kaplan-Meier survival analysis. RESULTS: Mean patient age was 56 years. The median OS for the group was 18.1 months. Median OS for patients undergoing gross total, near-total, and subtotal resection were 54, 16.5, and 13.2 months, respectively. Patients undergoing near-total resection (P = .05) or gross total resection (P &lt; .01) experienced statistically significant longer survival time than patients undergoing subtotal resection as well as patients undergoing ≥95% EOR (P &lt; .01) when compared to &lt;95% EOR. The addition of BCNU wafers had no survival advantage. CONCLUSIONS: The subpial technique extends the resection beyond the contrast enhancement and is associated with an overall survival beyond that seen in similar series where resection of the enhancement portion is performed. The effect of supratotal resection on survival exceeded the effects of age, Karnofsky performance score, and tumor volume. A prospective study would help to quantify the impact of the subpial technique on quality of life and survival as compared to a traditional resection limited to the enhancing tumor.
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Bălaşa, Adrian Florian, Corina Ionela Hurghiş, Flaviu Tămaş, et al. "Gross-total versus near-total resection of large vestibular schwannomas. An institutional experience." Romanian Journal of Morphology and Embryology 61, no. 2 (2020): 485–92. http://dx.doi.org/10.47162/rjme.61.2.18.
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Gump, William C., Karen L. Skjei, and Shefali N. Karkare. "Seizure control after subtotal lesional resection." Neurosurgical Focus 34, no. 6 (2013): E1. http://dx.doi.org/10.3171/2013.3.focus1348.
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Reports on seizure outcomes following surgery for lesional epilepsy consistently cite extent of resection as a significant predictor of outcome. Unfortunately, gross-total resection is not technically feasible in all cases of medically refractory tumor-associated epilepsy. Here, the authors present the case of a 4-year-old girl whose epilepsy was medically controlled after 1-stage electrocorticography-guided subtotal resection (STR) of a large diffuse protoplasmic astrocytoma. They also review the modern literature on epilepsy associated with brain tumors. Outcomes are compared with those following surgical treatment of focal cortical dysplasia and vascular lesions. Gross-total lesional resection shows significant superiority across pathologies and anatomical regions. Despite a considerable number of STRs yielding seizure freedom, other favorable treatment factors have not been defined. Although gross-total lesional resection, if possible, is clearly superior, tailored surgery may still offer patients a significant opportunity for a good outcome. Treatment factors yielding successful seizure control following STR remain to be fully elucidated.