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Jakola A.S.,Norwegian University of Science and Technology | Unsgard G.,Norwegian University of Science and Technology | Unsgard G.,National Center for 3trasound in Surgery | Myrmel K.S.,University of Tromsø | And 5 more authors.
PLoS ONE | Year: 2012

Background: Surgical management of suspected LGG remains controversial. A key factor when deciding a surgical strategy is often the tumors' perceived relationship to eloquent brain regions Objective: To study the association between tumor location, survival and long-term health related quality of life (HRQL) in patients with supratentorial low-grade gliomas (LGG). Methods: Adults (≥18 years) operated due to newly diagnosed LGG from 1998 through 2009 included from two Norwegian university hospitals. After review of initial histopathology, 153 adults with supratentorial WHO grade II LGG were included in the study. Tumors' anatomical location and the relationship to eloquent regions were graded. Survival analysis was adjusted for known prognostic factors and the initial surgical procedure (biopsy or resection). In long-term survivors, HRQL was assessed with disease specific questionnaires (EORTC QLQ-C30 and BN20) as well as a generic questionnaire (EuroQol 5D). Results: There was a significant association between eloquence and survival (log-rank, p<0.001). The estimated 5-year survival was 77% in non-eloquent tumors, 71% in intermediate located tumors and 54% in eloquent tumors. In the adjusted analysis the hazard ratio of increasing eloquence was 1.5 (95% CI 1.1-2.0, p = 0.022). There were no differences in HRQL between patients with eloquent and non-eloquent tumors. The most frequent self-reported symptoms were related to fatigue, cognition, and future uncertainty. Conclusion: Eloquently located LGGs are associated with impaired survival compared to non-eloquently located LGG, but in long-term survivors HRQL is similar. Although causal inference from observational data should be done with caution, the findings illuminate the delicate balance in surgical decision making in LGGs, and add support to the probable survival benefits of aggressive surgical strategies, perhaps also in eloquent locations. © 2012 Jakola et al.

Jakola A.S.,Norwegian University of Science and Technology | Gulati M.,Norwegian University of Science and Technology | Gulati S.,Norwegian University of Science and Technology | Solheim O.,Norwegian University of Science and Technology | Solheim O.,National Center for 3trasound in Surgery
Journal of Neuro-Oncology | Year: 2012

Meningiomas may influence both survival and neurological functions. Studies assessing the impact of surgery on health-related quality of life (HRQL) remain absent. In this prospective study we aimed to describe HRQL dynamics before and after surgery in patients with meningiomas. HRQL assessments were performed using EuroQol-5D (EQ-5D), a generic HRQL instrument. All adult patients with suspected intracranial meningioma from 2007 through 2011 were eligible for inclusion, and 54 patients were included after informed consent. All patients received a histopathological diagnosis of meningioma. The average preoperative EQ-5D index value (±SD) was 0.69 ± 0.26. The mean improvement 6 weeks after surgery was 0.06 (95 % CI, -0.03 to 0.16; p = 0.161) and the mean long term improvement was 0.09 (95 % CI, 0.00-0.17; p = 0.040). Surgery reduced pain/discomfort and anxiety/depression and improved the capability of performing usual activities. Clinically significant improvement at long-term assessment was noted in 25 patients (49 %) while a significant deterioration was reported in 10 patients (20 %). Patients who reported postoperative worsening of HRQL were also reporting better preoperative scores, suggesting a possible ceiling effect of EQ-5D in some of these patients. In our patients a modest average improvement in HRQL was seen after surgery for meningioma. About half of the patients reported a clinical important improvement at the late follow-up assessment. This improvement was mainly observed in the domains usual activities, pain/discomfort and anxiety/depression. However, one in five patients fared worse on late follow-up assessment, a figure of particular importance when treating asymptomatic meningiomas. © 2012 Springer Science+Business Media, LLC.

Solberg O.V.,Sintef | Solberg O.V.,National Center for 3trasound in Surgery | Solberg O.V.,Norwegian University of Science and Technology | Lindseth F.,Sintef | And 13 more authors.
Ultrasonics | Year: 2011

Freehand 3D ultrasound is increasingly being introduced in the clinic for diagnostics and image-assisted interventions. Various algorithms exist for combining 2D images of regular ultrasound probes to 3D volumes, being either voxel-, pixel- or function-based. Previously, the most commonly used input to 3D ultrasound reconstruction has been digitized analog video. However, recent scanners that offer access to digital image frames exist, either as processed or unprocessed data. To our knowledge, no comparison has been performed to determine which data source gives the best reconstruction quality. In the present study we compared both reconstruction algorithms and data sources using novel comparison methods for detecting potential differences in image quality of the reconstructed volumes. The ultrasound scanner used in this study was the Sonix RP from Ultrasonix Medical Corp (Richmond, Canada), a scanner that allow third party access to unprocessed and processed digital data. The ultrasound probe used was the L14-5/38 linear probe. The assessment is based on a number of image criteria: detectability of wire targets, spatial resolution, detectability of small barely visible structures, subjective tissue image quality, and volume geometry. In addition we have also performed the more "traditional" comparison of reconstructed volumes by removing a percentage of the input data. By using these evaluation methods and data from the specific scanner, the results showed that the processed video performed better than the digital scan-line data, digital video being better than analog video. Furthermore, the results showed that the choice of video source was more important than the choice of tested reconstruction algorithms. © 2010 Elsevier B.V. All rights reserved.

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