• Giuseppe M V Barbagallo, Stefano Palmucci, Massimiliano Visocchi, Sabrina Paratore, Giancarlo Attinà, Giuseppe Sortino, Vincenzo Albanese, and Francesco Certo.
• Departments of *Neurosurgery, ‡Radiodiagnostic and Oncological Radiotherapy, and §Anatomic Pathology, University Hospital Policlinico-Vittorio Emanuele, Catania, Italy; ¶Institute of Neurosurgery, Catholic University, Rome, Italy.
• Neurosurgery. 2015 Nov 9.

BackgroundIntraoperative magnetic resonance imaging is the gold standard among image-guided techniques for glioma surgery. Scant data are available on the role of intraoperative computed tomography (i-CT) in high-grade glioma (HGG) surgery.ObjectiveTo verify the technical feasibility and usefulness of portable i-CT in image-guided surgical resection of HGGs.MethodsThis is a retrospective series control analysis of prospectively collected data. Twenty-five patients (Group A) with HGGs underwent surgery using i-CT and 5-aminolevulinic acid (5-ALA) fluorescence. A second cohort of 25 patients (Group B) underwent 5-ALA fluorescence-guided surgery but without i-CT. We used a portable 8-slice CT scanner and, in both groups, neuronavigation. Extent of tumor resection (ETOR) and pre- and postoperative Karnofsky performance status (KPS) scores were measured; the impact of i-CT on overall survival (OS) and progression-free survival (PFS) was also analyzed.ResultsIn 8 patients (32%) in Group A, i-CT revealed residual tumor, and in 4 of them. it helped to also resect pathological tissue detached from the main tumor. EOTR in these 8 patients was 97.3% (96%-98.6%). In Group B, residual tumor was found in 6 patients, whose tumor's mean resection was 98% (93.5-99.7). The Student t test did not show statistically significant differences in EOTR in the 2 groups. The KPS score decreased from 67 to 69 after surgery in Group A and from 74 to 77 in Group B (P = .07 according to the Student t test). Groups A and B did not show statistically significant differences in OS and PFS (P = .61 and .46, respectively, by the log-rank test).ConclusionNo statistically significant differences in EOTR, KPS, PFS, and OS were observed in the 2 groups. However, i-CT helped to verify EOTR and to update the neuronavigator with real-time images, as well as to identify and resect pathological tissue in multifocal tumors. i-CT is a feasible and effective alternative to intraoperative magnetic resonance imaging. Portable i-CT can provide useful real-time information during brain surgery and can be easily introduced in neurosurgical theaters in daily practice.AbbreviationsEOTR, extent of tumor resectionGTR, gross total resectionHGG, high-grade gliomai-CT, intraoperative computed tomographyi-MRI, intraoperative magnetic resonance imagingKPS, Karnofsky Performance StatusOS, overall survivalPFS, progression-free survival.

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