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Article ; Online: Maximizing extent of resection while minimizing the risk of neurological morbidity in glioma patients: a novel grading scale to translate these surgical goals into a merged onco-functional clinical outcome.

Gerritsen, Jasper Kees Wim / Vincent, Arnaud Jean Pierre Edouard / De Vleeschouwer, Steven

2021 Volume 23, Issue 3, Page(s) 504–505

MeSH term(s)	Adult ; Brain Neoplasms/surgery ; Consensus ; Glioblastoma ; Glioma/surgery ; Goals ; Humans ; Morbidity
Language	English
Publishing date	2021-01-20
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	2028601-6
ISSN	1523-5866 ; 1522-8517
ISSN (online)	1523-5866
ISSN	1522-8517
DOI	10.1093/neuonc/noaa288
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Article: Safe surgery for glioblastoma: Recent advances and modern challenges.

Gerritsen, Jasper Kees Wim / Broekman, Marike Lianne Daphne / De Vleeschouwer, Steven / Schucht, Philippe / Nahed, Brian Vala / Berger, Mitchel Stuart / Vincent, Arnaud Jean Pierre Edouard

Neuro-oncology practice

2022 Volume 9, Issue 5, Page(s) 364–379

Abstract: One of the major challenges during glioblastoma surgery is balancing between maximizing extent of resection and preventing neurological deficits. Several surgical techniques and adjuncts have been developed to help identify eloquent areas both ... ...

Abstract	One of the major challenges during glioblastoma surgery is balancing between maximizing extent of resection and preventing neurological deficits. Several surgical techniques and adjuncts have been developed to help identify eloquent areas both preoperatively (fMRI, nTMS, MEG, DTI) and intraoperatively (imaging (ultrasound, iMRI), electrostimulation (mapping), cerebral perfusion measurements (fUS)), and visualization (5-ALA, fluoresceine)). In this review, we give an update of the state-of-the-art management of both primary and recurrent glioblastomas. We will review the latest surgical advances, challenges, and approaches that define the onco-neurosurgical practice in a contemporary setting and give an overview of the current prospective scientific efforts.
Language	English
Publishing date	2022-03-02
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2768945-1
ISSN	2054-2585 ; 2054-2577
ISSN (online)	2054-2585
ISSN	2054-2577
DOI	10.1093/nop/npac019
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Article ; Online: Sustainable and cost-effective MAS DNP-NMR at 30 K with cryogenic sample exchange.

Paul, Subhradip / Bouleau, Eric / Reynard-Feytis, Quentin / Arnaud, Jean-Pierre / Bancel, Florian / Rollet, Bertrand / Dalban-Moreynas, Pierre / Reiter, Christian / Purea, Armin / Engelke, Frank / Hediger, Sabine / De Paëpe, Gaël

Journal of magnetic resonance (San Diego, Calif. : 1997)

2023 Volume 356, Page(s) 107561

Abstract: We report here instrumental developments to achieve sustainable, cost-effective cryogenic Helium sample spinning in order to conduct dynamic nuclear polarisation (DNP) and solid-state NMR (ssNMR) at ultra-low temperatures (<30 K). More specifically, we ... ...

Abstract	We report here instrumental developments to achieve sustainable, cost-effective cryogenic Helium sample spinning in order to conduct dynamic nuclear polarisation (DNP) and solid-state NMR (ssNMR) at ultra-low temperatures (<30 K). More specifically, we describe an efficient closed-loop helium system composed of a powerful heat exchanger (95% efficient), a single cryocooler, and a single helium compressor to power the sample spinning and cooling. The system is integrated with a newly designed triple-channel NMR probe that minimizes thermal losses without compromising the radio frequency (RF) performance and spinning stability (±0.05%). The probe is equipped with an innovative cryogenic sample exchange system that allows swapping samples in minutes without introducing impurities in the closeloop system. We report that significant gain in sensitivity can be obtained at 30-40 K on large micro-crystalline molecules with unfavorable relaxation timescales, making them difficult or impossible to polarize at 100 K. We also report rotor-synchronized 2D experiments to demonstrate the stability of the system.
Language	English
Publishing date	2023-09-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	1469665-4
ISSN	1096-0856 ; 1557-8968 ; 1090-7807 ; 0022-2364
ISSN (online)	1096-0856 ; 1557-8968
ISSN	1090-7807 ; 0022-2364
DOI	10.1016/j.jmr.2023.107561
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Article ; Online: Preoperative assessment of eloquence in neurosurgery: a systematic review.

Rammeloo, Emma / Schouten, Joost Willem / Krikour, Keghart / Bos, Eelke Marijn / Berger, Mitchel Stuart / Nahed, Brian Vala / Vincent, Arnaud Jean Pierre Edouard / Gerritsen, Jasper Kees Wim

Journal of neuro-oncology

2023 Volume 165, Issue 3, Page(s) 413–430

Abstract: Background and objectives: Tumor location and eloquence are two crucial preoperative factors when deciding on the optimal treatment choice in glioma management. Consensus is currently lacking regarding the preoperative assessment and definition of ... ...

Abstract	Background and objectives: Tumor location and eloquence are two crucial preoperative factors when deciding on the optimal treatment choice in glioma management. Consensus is currently lacking regarding the preoperative assessment and definition of eloquent areas. This systematic review aims to evaluate the existing definitions and assessment methods of eloquent areas that are used in current clinical practice. Methods: A computer-aided search of Embase, Medline (OvidSP), and Google Scholar was performed to identify relevant studies. This review includes articles describing preoperative definitions of eloquence in the study's Methods section. These definitions were compared and categorized by anatomical structure. Additionally, various techniques to preoperatively assess tumor eloquence were extracted, along with their benefits, drawbacks and ease of use. Results: This review covers 98 articles including 12,714 participants. Evaluation of these studies indicated considerable variability in defining eloquence. Categorization of these definitions yielded a list of 32 brain regions that were considered eloquent. The most commonly used methods to preoperatively determine tumor eloquence were anatomical classification systems and structural MRI, followed by DTI-FT, functional MRI and nTMS. Conclusions: There were major differences in the definitions and assessment methods of eloquence, and none of them proved to be satisfactory to express eloquence as an objective, quantifiable, preoperative factor to use in glioma decision making. Therefore, we propose the development of a novel, objective, reliable, preoperative classification system to assess eloquence. This should in the future aid neurosurgeons in their preoperative decision making to facilitate personalized treatment paradigms and to improve surgical outcomes.
MeSH term(s)	Humans ; Neurosurgery ; Brain Mapping/methods ; Diffusion Tensor Imaging/methods ; Brain/surgery ; Glioma/diagnostic imaging ; Glioma/surgery ; Brain Neoplasms/surgery
Language	English
Publishing date	2023-12-14
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	604875-4
ISSN	1573-7373 ; 0167-594X
ISSN (online)	1573-7373
ISSN	0167-594X
DOI	10.1007/s11060-023-04509-x
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Article: Prospective randomized study comparing quality of life after shoudice or mesh plug repair for inguinal hernia: short-term results.

Lermite, Emilie / Arnaud, Jean-Pierre

Surgical technology international

2012 Volume 22, Page(s) 101–106

Abstract: Postoperative pain is a major obstacle in hernia repair surgery, and the choice of clinically efficacious surgical technique should also result in the least postoperative pain and patients' quality of life (QoL). The aim of this prospective randomized ... ...

Abstract	Postoperative pain is a major obstacle in hernia repair surgery, and the choice of clinically efficacious surgical technique should also result in the least postoperative pain and patients' quality of life (QoL). The aim of this prospective randomized study was to compare two surgical techniques for open inguinal hernia repair by assessing the patients' QoL. Men (18-to-75 years old) with primary unilateral inguinal hernia underwent Mesh Plug (MP; n = 156; Bard (PerFix Plug, CR Bard Inc, Murray Hill, NJ) and Shouldice (S; n = 144) techniques. We evaluated: 1) Intensity of postoperative pain (visual analog scale [VAS]) and 2) quality of life (QoL; Medical Outcomes Study Short-Form 36 [SF-36]). Patients undergoing MP had significantly lower VAS scores on postoperative days (POD) 1 (22.1 vs 27.4, p = .003) and 2 (13.2 vs 21.4, p < .0001) compared to those in the S group. The QoL was also improved in patients undergoing MP on PODs 8 and 45. Total duration of operation, length of hospital stay, and cessation of normal activities were significantly shorter in the MP group. Compared to the S technique, the MP technique results in significantly less postoperative pain and improved QoL.
MeSH term(s)	Adolescent ; Adult ; Aged ; France/epidemiology ; Hernia, Inguinal/diagnosis ; Hernia, Inguinal/epidemiology ; Hernia, Inguinal/surgery ; Herniorrhaphy/instrumentation ; Herniorrhaphy/methods ; Herniorrhaphy/statistics & numerical data ; Humans ; Male ; Middle Aged ; Pain Measurement/statistics & numerical data ; Pain, Postoperative/diagnosis ; Pain, Postoperative/epidemiology ; Pain, Postoperative/prevention & control ; Patient Satisfaction/statistics & numerical data ; Prevalence ; Prospective Studies ; Quality of Life ; Risk Factors ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2012-12
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	1225512-9
ISSN	1090-3941
ISSN	1090-3941
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Article ; Online: Impact of dedicated neuro-anesthesia management on clinical outcomes in glioblastoma patients: A single-institution cohort study.

Gerritsen, Jasper Kees Wim / Rizopoulos, Dimitris / Schouten, Joost Willem / Haitsma, Iain Kristian / Eralp, Ismail / Klimek, Markus / Dirven, Clemens Maria Franciscus / Vincent, Arnaud Jean Pierre Edouard

PloS one

2022 Volume 17, Issue 12, Page(s) e0278864

Abstract: Background: Glioblastomas are mostly resected under general anesthesia under the supervision of a general anesthesiologist. Currently, it is largely unkown if clinical outcomes of GBM patients can be improved by appointing a neuro-anesthesiologist for ... ...

Abstract	Background: Glioblastomas are mostly resected under general anesthesia under the supervision of a general anesthesiologist. Currently, it is largely unkown if clinical outcomes of GBM patients can be improved by appointing a neuro-anesthesiologist for their cases. We aimed to evaluate whether the assignment of dedicated neuro-anesthesiologists improves the outcomes of these patients. We also investigated the value of dedicated neuro-oncological surgical teams as an independent variable in both groups. Methods: A cohort consisting of 401 GBM patients who had undergone resection was retrospectively investigated. Primary outcomes were postoperative neurological complications, fluid balance, length-of-stay and overall survival. Secondary outcomes were blood loss, anesthesia modality, extent of resection, total admission costs, and duration of surgery. Results: 320 versus 81 patients were operated under the anesthesiological supervision of a general anesthesiologist and a dedicated neuro-anesthesiologist, respectively. Dedicated neuro-anesthesiologists yielded significant superior outcomes in 1) postoperative neurological complications (early: p = 0.002, OR = 2.54; late: p = 0.003, OR = 2.24); 2) fluid balance (p<0.0001); 3) length-of-stay (p = 0.0006) and 4) total admission costs (p = 0.0006). In a subanalysis of the GBM resections performed by an oncological neurosurgeon (n = 231), the assignment of a dedicated neuro-anesthesiologist independently improved postoperative neurological complications (early minor: p = 0.0162; early major: p = 0.00780; late minor: p = 0.00250; late major: p = 0.0364). The assignment of a dedicated neuro-oncological team improved extent of resection additionally (p = 0.0416). Conclusion: GBM resections with anesthesiological supervision of a dedicated neuro-anesthesiologists are associated with improved patient outcomes. Prospective evidence is needed to further investigate the usefulness of the dedicated neuro-anesthesiologist in different settings.
MeSH term(s)	Humans ; Glioblastoma/surgery ; Cohort Studies ; Retrospective Studies ; Prospective Studies ; Anesthesia, General ; Postoperative Complications
Language	English
Publishing date	2022-12-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0278864
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Article ; Online: Impact of intraoperative stimulation mapping on high-grade glioma surgery outcome: a meta-analysis.

Gerritsen, Jasper Kees Wim / Arends, Lidia / Klimek, Markus / Dirven, Clemens Maria Franciscus / Vincent, Arnaud Jean-Pierre Edouard

Acta neurochirurgica

2018 Volume 161, Issue 1, Page(s) 99–107

Abstract: Background: Intraoperative stimulation mapping (ISM) using electrocortical mapping (awake craniotomy, AC) or evoked potentials has become a solid option for the resection of supratentorial low-grade gliomas in eloquent areas, but not as much for high- ... ...

Abstract	Background: Intraoperative stimulation mapping (ISM) using electrocortical mapping (awake craniotomy, AC) or evoked potentials has become a solid option for the resection of supratentorial low-grade gliomas in eloquent areas, but not as much for high-grade gliomas. This meta-analysis aims to determine whether the surgeon, when using ISM and AC, is able to achieve improved overall survival and decreased neurological morbidity in patients with high-grade glioma as compared to resection under general anesthesia (GA). Methods: A systematic search was performed to identify relevant studies. Adult patients were included who had undergone craniotomy for high-grade glioma (WHO grade III or IV) using ISM (among which AC) or GA. Primary outcomes were rate of postoperative complications, overall postoperative survival, and percentage of gross total resections (GTR). Secondary outcomes were extent of resection and percentage of eloquent areas. Results: Review of 2049 articles led to the inclusion of 53 studies in the analysis, including 9102 patients. The overall postoperative median survival in the AC group was significantly longer (16.87 versus 12.04 months; p < 0.001) and the postoperative complication rate was significantly lower (0.13 versus 0.21; p < 0.001). Mean percentage of GTR was significantly higher in the ISM group (79.1% versus 47.7%, p < 0.0001). Extent of resection and preoperative patient KPS were indicated as prognostic factors, whereas patient KPS and involvement of eloquent areas were identified as predictive factors. Conclusions: These findings suggest that surgeons using ISM and AC during their resections of high-grade glioma in eloquent areas experienced better surgical outcomes: a significantly longer overall postoperative survival, a lower rate of postoperative complications, and a higher percentage of GTR.
MeSH term(s)	Brain Mapping/adverse effects ; Brain Mapping/methods ; Brain Neoplasms/surgery ; Craniotomy/adverse effects ; Craniotomy/methods ; Deep Brain Stimulation/adverse effects ; Glioma/surgery ; Humans ; Intraoperative Neurophysiological Monitoring/adverse effects ; Intraoperative Neurophysiological Monitoring/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Wakefulness
Language	English
Publishing date	2018-11-21
Publishing country	Austria
Document type	Journal Article ; Meta-Analysis
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-018-3732-4
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Article ; Online: The PROGRAM study

Sandro M Krieg / Steven De Vleeschouwer / Philippe Schucht / Jasper Kees Wim Gerritsen / Clemens Maria Franciscus Dirven / Christine Jungk / Brian Vala Nahed / Mitchel Stuart Berger / Marike Lianne Daphne Broekman / Arnaud Jean Pierre Edouard Vincent

BMJ Open, Vol 11, Iss

awake mapping versus asleep mapping versus no mapping for high-grade glioma resections: study protocol for an international multicenter prospective three-arm cohort study

2021 Volume 7

Abstract: Introduction The main surgical dilemma during glioma resections is the surgeon’s inability to accurately identify eloquent areas when the patient is under general anaesthesia without mapping techniques. Intraoperative stimulation mapping (ISM) techniques ...

Abstract	Introduction The main surgical dilemma during glioma resections is the surgeon’s inability to accurately identify eloquent areas when the patient is under general anaesthesia without mapping techniques. Intraoperative stimulation mapping (ISM) techniques can be used to maximise extent of resection in eloquent areas yet simultaneously minimise the risk of postoperative neurological deficits. ISM has been widely implemented for low-grade glioma resections backed with ample scientific evidence, but this is not yet the case for high-grade glioma (HGG) resections. Therefore, ISM could thus be of important value in HGG surgery to improve both surgical and clinical outcomes.Methods and analysis This study is an international, multicenter, prospective three-arm cohort study of observational nature. Consecutive HGG patients will be operated with awake mapping, asleep mapping or no mapping with a 1:1:1 ratio. Primary endpoints are: (1) proportion of patients with National Institute of Health Stroke Scale deterioration at 6 weeks, 3 months and 6 months after surgery and (2) residual tumour volume of the contrast-enhancing and non-contrast-enhancing part as assessed by a neuroradiologist on postoperative contrast MRI scans. Secondary endpoints are: (1) overall survival and (2) progression-free survival at 12 months after surgery; (3) oncofunctional outcome and (4) frequency and severity of serious adverse events in each arm. Total duration of the study is 5 years. Patient inclusion is 4 years, follow-up is 1 year.Ethics and dissemination The study has been approved by the Medical Ethics Committee (METC Zuid-West Holland/Erasmus Medical Center; MEC-2020–0812). The results will be published in peer-reviewed academic journals and disseminated to patient organisations and media.Trial registration number ClinicalTrials.gov ID number NCT04708171 (PROGRAM-study), NCT03861299 (SAFE-trial)
Keywords	Medicine ; R
Subject code	616
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The PROGRAM study: awake mapping versus asleep mapping versus no mapping for high-grade glioma resections: study protocol for an international multicenter prospective three-arm cohort study.

Gerritsen, Jasper Kees Wim / Dirven, Clemens Maria Franciscus / De Vleeschouwer, Steven / Schucht, Philippe / Jungk, Christine / Krieg, Sandro M / Nahed, Brian Vala / Berger, Mitchel Stuart / Broekman, Marike Lianne Daphne / Vincent, Arnaud Jean Pierre Edouard

BMJ open

2021 Volume 11, Issue 7, Page(s) e047306

Abstract: Introduction: The main surgical dilemma during glioma resections is the surgeon's inability to accurately identify eloquent areas when the patient is under general anaesthesia without mapping techniques. Intraoperative stimulation mapping (ISM) ... ...

Abstract	Introduction: The main surgical dilemma during glioma resections is the surgeon's inability to accurately identify eloquent areas when the patient is under general anaesthesia without mapping techniques. Intraoperative stimulation mapping (ISM) techniques can be used to maximise extent of resection in eloquent areas yet simultaneously minimise the risk of postoperative neurological deficits. ISM has been widely implemented for low-grade glioma resections backed with ample scientific evidence, but this is not yet the case for high-grade glioma (HGG) resections. Therefore, ISM could thus be of important value in HGG surgery to improve both surgical and clinical outcomes. Methods and analysis: This study is an international, multicenter, prospective three-arm cohort study of observational nature. Consecutive HGG patients will be operated with awake mapping, asleep mapping or no mapping with a 1:1:1 ratio. Primary endpoints are: (1) proportion of patients with National Institute of Health Stroke Scale deterioration at 6 weeks, 3 months and 6 months after surgery and (2) residual tumour volume of the contrast-enhancing and non-contrast-enhancing part as assessed by a neuroradiologist on postoperative contrast MRI scans. Secondary endpoints are: (1) overall survival and (2) progression-free survival at 12 months after surgery; (3) oncofunctional outcome and (4) frequency and severity of serious adverse events in each arm. Total duration of the study is 5 years. Patient inclusion is 4 years, follow-up is 1 year. Ethics and dissemination: The study has been approved by the Medical Ethics Committee (METC Zuid-West Holland/Erasmus Medical Center; MEC-2020-0812). The results will be published in peer-reviewed academic journals and disseminated to patient organisations and media. Trial registration number: ClinicalTrials.gov ID number NCT04708171 (PROGRAM-study), NCT03861299 (SAFE-trial).
MeSH term(s)	Brain Mapping ; Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/surgery ; Cohort Studies ; Glioma/diagnostic imaging ; Glioma/surgery ; Humans ; Multicenter Studies as Topic ; Observational Studies as Topic ; Prospective Studies ; Wakefulness
Language	English
Publishing date	2021-07-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-047306
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Article ; Online: Awake craniotomy versus craniotomy under general anesthesia without surgery adjuncts for supratentorial glioblastoma in eloquent areas: a retrospective matched case-control study.

Gerritsen, Jasper Kees Wim / Viëtor, Charlotte Lauren / Rizopoulos, Dimitris / Schouten, Joost Willem / Klimek, Markus / Dirven, Clemens Maria Franciscus / Vincent, Arnaud Jean-Pierre Edouard

Acta neurochirurgica

2019 Volume 161, Issue 2, Page(s) 307–315

Abstract: Background: Awake craniotomy with electrocortical and subcortical mapping (AC) has become the mainstay of surgical treatment of supratentorial low-grade gliomas in eloquent areas, but not as much for glioblastomas.: Objective: This retrospective ... ...

Abstract	Background: Awake craniotomy with electrocortical and subcortical mapping (AC) has become the mainstay of surgical treatment of supratentorial low-grade gliomas in eloquent areas, but not as much for glioblastomas. Objective: This retrospective controlled-matched study aims to determine whether AC increases gross total resections (GTR) and decreases neurological morbidity in glioblastoma patients as compared to resection under general anesthesia (GA, conventional). Methods: Thirty-seven patients with glioblastoma undergoing AC were 1:3 controlled-matched with 111 patients undergoing GA for glioblastoma resection. The two groups were matched for age, gender, preoperative Karnofsky Performance Score (KPS), preoperative tumor volume, tumor location, and type of adjuvant treatment. Primary outcomes were extent of resection and the rate of postoperative complications. The secondary outcome was overall postoperative survival. Results: After matching, there were no significant differences in clinical variables between groups. Extent of resection was significantly higher in the AC group: mean extent of resection in the AC group was 94.89% (SD = 10.57) as compared to 70.30% (SD = 28.37) in the GA group (p = 0.0001). Furthermore, the mean rate of late minor postoperative complications in the AC group (0.03; SD = - 0.16) was significantly lower than in the GA group (0.15; SD = 0.39) (p = 0.05). No significant differences between groups were found for the other subgroups of postoperative complications. Moreover, overall postoperative survival did not differ between groups (p = 0.297). Conclusion: These findings suggest that resection of glioblastoma using AC is associated with significantly greater extent of resection and less late minor postoperative complications as compared with craniotomy under GA without the use of surgery adjuncts. However, due to certain limitations inherent to our study design (selection bias) and the absence of the use of surgery adjuncts in the GA group, we advocate for a prospective study to further build upon this evidence and study the use of AC in glioblastoma patients.
MeSH term(s)	Adult ; Aged ; Anesthesia, General/adverse effects ; Brain Neoplasms/surgery ; Craniotomy/adverse effects ; Craniotomy/methods ; Female ; Glioblastoma/surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology
Language	English
Publishing date	2019-01-07
Publishing country	Austria
Document type	Evaluation Study ; Journal Article
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-018-03788-y
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