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Imaging and Operative Techniques for Glioma Surgery

Dr. Kevin Petrecca, Department of Neurology and Neurosurgery, McGill

Imaging and Operative Techniques for Glioma Surgery

What
  • CREATE-MIA Event
  • Seminar
When Sep 13, 2013
from 03:30 PM to 04:30 PM
Where McConnell Engineering MC103
Attendees All CREATE-MIA Trainees
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Abstract

Malignant gliomas are the most common adult primary brain cancers and are amongst the most devastating of human malignancies. These cancers are characterized by high proliferation and invasion into normal brain. The goal of surgery is to remove the entirety of the tumor as strong emerging evidence suggests that completeness of resection improves cancer control and lengthens survival.

Studies examining the location of malignant glioma recurrence following surgery and adjuvant radiotherapy and chemotherapy have found that most cancers recur within a 1 cm border along the surgical resection cavity, even in cases in which no residual gadolinium-enhancing tumor was evident on immediate post-operative MRI. This suggests that gadolinium-enhanced MRI does not sufficiently reveal the entire tumor resulting in residual tumor post-operatively. Other common MRI sequences, including FLAIR and T2, do not adequately distinguish non-gadolinium enhancing cancer cells from peritumoral edema. The inability to accurately visualize the whole tumor, including invasive cells, on imaging decreases the likelihood of complete resection.

Since malignant gliomas are highly invasive tumors, the margin between tumor and normal brain is typically not obvious. Reluctant to cause an irreversible neurological deficit, surgeons will error on the side of caution. The downside is that malignant cancer cells will remain. Since adjuvant radiation and chemotherapies are only modestly effective, these cancer cells that remain along the border of the original tumor mass will recur.  Intraoperative tools designed to help surgeons distinguish cancer cells from normal brain include ultrasound and fluorescence guided surgical resection.  Comparative studies using these tools have shown higher rates of complete resection compared to standard operating techniques.

In this session we will review current and emerging imaging technologies designed to better visualize the tumor on preoperative imaging. We also review developing surgical technologies to help surgeons distinguish cancer cells from normal brain intraoperatively. The development of these technologies will lead to an increased rate of complete resection and thus improved cancer control.

Biography

Dr. Kevin Petrecca is a neurosurgeon and Assistant Professor of Neurology and Neurosurgery at McGill University who specializes in neurosurgical oncology. His research at the MNI/H Brain Tumour Research Centre focuses on understanding fundamental molecular mechanisms that regulate cell motility with a focus on malignant glial cell invasion. Malignant gliomas are the most common type of primary brain cancer and among the most devastating of human malignancies. They are characterized by rapid cell proliferation and invasion into the surrounding normal brain. Malignant glial cell invasion is the leading cause of tumour recurrence and of treatment failure. Dr. Petrecca's basic science research aims to identify and characterize fundamental molecular mechanisms that regulate glial cell movement and translate these findings into useful therapeutics. His clinical research program focuses on developing intraoperative tools to improve brain cancer surgery including MRI-coregistered ultrasound and fluorescence-guided surgery.

 

Note: MC103 is located in the McConnell Engineering building.  Click here for a map.


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Funded by NSERC

Funding provided by NSERC