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.

We evaluated the rupture risk of multiple cerebral aneurysms in aspects of various morphological parameters, and determined which parameter can be a reliable predictor as one aneurysm ruptured, and the others did not. Between 2007 and 2012, three-dimensional (3D) angiographic images of 85 patients harboring multiple aneurysms (85 ruptured and 104 unruptured aneurysms) were used to assess the following morphological parameters: geometry of the aneurysm itself, e.g., maximal size, aspect ratio, bottleneck ratio, height/width ratio, undulation, and daughter sac; architecture of the aneurysm and surrounding vessels, e.g. aneurysmal angle, vessel angle, inflow angle, parent-daughter angle, and size ratio type I & II. Univariate analysis was applied to all parameters, and significant parameters were identified in multivariate analysis, yielding the cut-off point from receiver-operating characteristic (ROC) curve analysis. On multivariate logistic regression, the aspect ratio [odds ratio (OR), 1.21; 95% confidence interval (CI), 1.05-1.41] and daughter sac (OR, 3.12; 95% CI, 1.05-9.27) were significant parameters in geometries of the aneurysm itself. The size ratio type I (OR, 1.14; 95% CI, 1.05-1.22) and parent-daughter angle (OR, 1.02; 95% CI, 1.00-1.04) were independent parameters in architecture of the aneurysm and surrounding vessels. From the ROC curve, the aspect ratio and size ratio type I had cut-off values of 1.3 and 1.8, respectively. Several morphological parameters were investigated to predict a rupture in multiple cerebral aneurysms using 3D angiogram. The aspect ratio, size ratio type I, daughter sac, and parent-daughter angle were revealed as competent parameters.

Background: Stereotactic biopsy is a standard procedure for brain biopsy. However, with advances in technology, navigation-guided brain biopsy has become a well-established alternative. Previous studies have shown that frameless stereotactic brain biopsy is as effective and safe as frame-based stereotactic brain biopsy is. In this study, the authors evaluate the diagnostic yield and complication rate of frameless intracranial biopsy. Materials and Methods: We reviewed data from biopsy performed patients between March 2014 and April 2022. We retrospectively reviewed medical records, including imaging studies. Various intracerebral lesions were biopsied. Diagnostic yield and post-operative complications were compared with those of frame-based stereotactic biopsy. Results: Forty-two frameless navigation-guided biopsy were performed, and the most common pathology was primary central nervous system lymphoma (35.7%), followed by glioblastoma (33.3%), and anaplastic astrocytomas (16.7%), respectively. The diagnostic yield was 100%. Post-operative intracerebral hematoma occurred in 2.4% of cases, but it was not symptomatic. Thirty patients underwent frame-based stereotactic biopsy, and the diagnostic yield was 96.7%. There was no difference in diagnostic rates between two methods (Fisher’s exact test, p = 0.916). Conclusions: Frameless navigation-guided biopsy is as effective as frame-based stereotactic biopsy is, without causing further complications. We consider that frame-based stereotactic biopsy is no longer needed if frameless navigation-guided biopsy is used. A further study will be needed to generalize our results.