• Eef J Hendriks, Sander Idema, Shawn L Hervey-Jumper, Anne-Laure Bernat, Aeilko H Zwinderman, Frederik Barkhof, W Peter Vandertop, Emmanuel Mandonnet, Hugues Duffau, Mitchel S Berger, and Philip C De Witt Hamer.
• Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
• Neurosurgery. 2019 Aug 1; 85 (2): E304-E313.

BackgroundPreoperative interpretation of resectability of diffuse nonenhancing glioma is primarily based on individual surgical expertise.ObjectiveTo compare the accuracy and precision between observed resections and preoperative estimates of neurosurgeons and a resection probability map (RPM). We hypothesize that the RPM estimates is as good as senior neurosurgeons.MethodsA total of 234 consecutive patients were included from 2 centers, who had resective surgery with functional mapping between 2006 and 2012 for a supra-tentorial nonenhancing glioma. Extent of resection (EOR) and residual tumor volume (RTV) were segmented and an RPM was constructed in standard brain space. Three junior and three senior neurosurgeons estimated EOR and RTV, blinded for postoperative results. We determined the agreement between the estimates and calculated the diagnostic accuracy of the neurosurgeons and the RPM to predict the observed resections.ResultsPreoperative estimates of resection results by junior and senior neurosurgeons were significantly biased towards overestimation of EOR (4.2% and 11.2%) and underestimation of RTV (4.3 and 9.0 mL), whereas estimates of the RPM were unbiased (-2.6% and -.2 mL, respectively). The limits of agreement were wide for neurosurgeons and for the RPM. The RPM was significantly more accurate in identifying patients in whom an EOR >40% was observed than neurosurgeons.ConclusionNeurosurgeons estimate preoperative resectability before surgery of a nonenhancing glioma rather accurate-with a small bias-and imprecise-with wide limits of agreement. An RPM provides unbiased resectability estimates, which can be useful for surgical decision-making, planning, and education.Copyright © 2018 by the Congress of Neurological Surgeons.

27 keywords...

hide…