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Meta-analysis of overall survival and postoperative neurologic deficits after resection or biopsy of butterfly glioblastoma

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Abstract

Butterfly glioblastoma (bGBM) is a grade 4 glioma with a poor prognosis. Surgical treatment of these cancers has been reviewed in the literature with some recent studies supporting resection as a safe and effective treatment instead of biopsy and adjuvant therapy. This meta-analysis was designed to determine whether there are significant differences in overall survival (OS) and postoperative neurologic deficits (motor, speech, and cranial nerve) following intervention in patients who underwent tumor resection as part of their treatment, compared to patients who underwent biopsy without surgical resection. A literature search was conducted using PubMed (National Library of Medicine) and Embase (Elsevier) to identify articles from each database’s earliest records to May 25, 2021, that directly compared the outcomes of biopsy and resection in bGBM patients and met predetermined inclusion criteria. A meta-analysis was conducted to compare the effects of the two management strategies on OS and postoperative neurologic deficits. Six articles met our study inclusion criteria. OS was found to be significantly longer for the resection group at 6 months (odds ratio [OR] 2.94, 95% confidence interval [CI] 1.23–7.05) and 12 months (OR 3.75, 95% CI 1.10–12.76) than for the biopsy group. No statistically significant differences were found in OS at 18 and 24 months. Resection was associated with an increased rate of postoperative neurologic deficit (OR 2.05, 95% CI 1.02–4.09). Resection offers greater OS up to 1 year postintervention than biopsy alone; however, this comes at the cost of higher rates of postoperative neurologic deficits.

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Data availability

The data that support the findings of this study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Paul H. Dressel BFA for formatting the figures and Carrie Owens MSILS and Debra J. Zimmer for editorial support.

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Authors and Affiliations

  1. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA

    Mohamed AR Soliman, Asham Khan, Moleca M Ghannam, Ryan M Hess, Jaims Lim, Jeffrey P Mullin, Jason M Davies, John Pollina, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy, Robert J Plunkett & Robert A Fenstermaker

  2. Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA

    Mohamed AR Soliman, Asham Khan, Moleca M Ghannam, Ryan M Hess, Jaims Lim, Jeffrey P Mullin, Jason M Davies, John Pollina, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy & Robert J Plunkett

  3. Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt

    Mohamed AR Soliman

  4. Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA

    Shady Azmy, Slah Khan, Ryan Goliber & Eric J Szczecinski

  5. School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Olivia Gilbert

  6. Dow International Medical College, Karachi, Sindh, Pakistan

    Hamza Durrani

  7. Cornell University, Ithaca, NY, USA

    Samantha Burke

  8. Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt

    Amany A Salem

  9. Department of Biomedical Sciences, University of Windsor, Windsor, Ontario, Canada

    Dorota Lubanska

  10. Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Jason M Davies

  11. Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA

    Jason M Davies, Kenneth V Snyder, Adnan H Siddiqui & Elad I Levy

  12. Jacobs Institute, Buffalo, NY, USA

    Jason M Davies, Kenneth V Snyder, Adnan H Siddiqui & Elad I Levy

  13. Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Adnan H Siddiqui & Elad I Levy

  14. Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA

    Robert J Plunkett & Robert A Fenstermaker

Authors
  1. Mohamed AR Soliman
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  2. Asham Khan
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  3. Shady Azmy
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  4. Olivia Gilbert
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  5. Slah Khan
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  6. Ryan Goliber
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  7. Eric J Szczecinski
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  8. Hamza Durrani
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  9. Samantha Burke
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  10. Amany A Salem
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  11. Dorota Lubanska
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  12. Moleca M Ghannam
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  13. Ryan M Hess
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  14. Jaims Lim
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  15. Jeffrey P Mullin
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  16. Jason M Davies
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  17. John Pollina
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  18. Kenneth V Snyder
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  19. Adnan H Siddiqui
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  20. Elad I Levy
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  21. Robert J Plunkett
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  22. Robert A Fenstermaker
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Contributions

Conception and design: Soliman, A Khan, Fenstermaker, Plunkett.

Acquisition of data: Azmy, Gilbert, Goliber, Szczecinski, Durrani, Burke.

Interpretation of data: all authors.

Drafting the manuscript: Azmy, Soliman.

Critically revising the manuscript: all authors.

Reviewed submitted version of manuscript: all authors.

Statistical analysis: S Khan, Salem.

Study supervision: Siddiqui, Fenstermaker, Plunkett.

Corresponding author

Correspondence to Robert A Fenstermaker.

Ethics declarations

Ethics approval and consent to participate

The University at Buffalo Institutional Review Board determined that this study was not research involving human subjects and that their review and approval was not required. Additionally, consent to participate was not required.

Human and animal ethics

Not applicable.

Consent for publication

Not applicable.

Competing interests

Dr. Fenstermaker is a co-founder and equity holder in MimiVax, LLC, which develops immunotherapeutic agents for treatment of glioblastoma.

Dr. A. Khan has received research grants from the Scoliosis Research Society to study scoliosis in Chiari patients and from the Neurosurgical Research and Education Foundation (NREF) to study bupivacaine pain pumps in patients undergoing spinal deformity correction.

Dr. Davies consulting fees, payment, or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events; support for attending meetings and/or travel: Medtronic. Patents planned, issued, or pending: QAS.ai. Participation on a Data Safety Monitoring Board or Advisory Board: NIH NIHDS Strokenet. Stock or stock options: Synchron, Cerebrotech, QAS.ai.

Dr. Levy shareholder/ownership interest: NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, Three Rivers Medical; Patent: Bone Scalpel; Honorarium for Training and Lectures: Medtronic, Penumbra, MicroVention, Integra, Consultant: Clarion, GLG Consulting, Guidepoint Global, Imperative Care, Medtronic, StimMed, Misionix, Mosiac; Chief Medical Officer: Haniva Technology; National PI: Medtronic- Steering Committees for SWIFT Prime and SWIFT Direct Trials; Site PI Study: MicroVention (CONFIDENCE Study) Medtronic (STRATIS Study-Sub 1); Advisory Board: Stryker (AIS Clinical Advisory Board), NeXtGen Biologics, MEDX, Cognition Medical; Endostream Medical, IRRAS AB (Consultant/Advisory Board, Medical Legal Review): render medical/legal opinions as an expert witness; leadership or fiduciary roles in other board society, committee, or advocacy group, paid and unpaid: CNS, ABNS, UBNS.

Dr. Mullin is involved with clinical research for Cerapedics. He receives research funding from AOSpine North America (AOSNA) and the Research Committee Award #87639; and from Medtronic External Research Program Health Professionals, ERP ID#2020–12271.

Dr. Plunkett is a non-paid consultant for Medtronic and a contributing investigator for the Medtronic Product Registry.

Dr. Pollina is involved with surgical training for Medtronic and serves as a consultant for and receives royalties from ATEC Spine.

Dr. Siddiqui consulting fees: Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, Cerebrotech Medical Systems, Inc., Cerenovus, Cerevatech Medical, Inc., Cordis, Corindus, Inc., Endostream Medical, Ltd, Imperative Care, InspireMD, Ltd., Integra, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Inc., Peijia Medical, Penumbra, Q’Apel Medical, Inc., Rapid Medical, Serenity Medical, Inc., Silk Road Medical, StimMed, LLC, Stryker Neurovascular, Three Rivers Medical, Inc., VasSol, Viz.ai, Inc. Leadership or fiduciary role in other board, society, committee, or advocacy group: Secretary – Board of the Society of NeuroInterventional Surgery 2020–2021, Chair –Cerebrovascular Section of the AANS/CNS 2020–2021. Stock or stock options: Adona Medical, Inc., Amnis Therapeutics, Bend, IT Technologies, Ltd., BlinkTBI, Inc, Cerebrotech Medical Systems, Inc., Cerevatech Medical, Inc., Cognition Medical, CVAID Ltd., E8, Inc., Endostream Medical, Ltd, Galaxy Therapeutics, Inc., Imperative; Care, Inc., InspireMD, Ltd., Instylla, Inc., International Medical Distribution Partners, Launch NY, Inc.; Neurolutions, Inc., NeuroRadial Technologies, Inc., NeuroTechnology Investors, Neurovascular Diagnostics, Inc., Peijia; Medical, PerFlow Medical, Ltd., Q’Apel Medical, Inc., QAS.ai, Inc., Radical Catheter Technologies, Inc., Rebound Therapeutics Corp. (Purchased 2019 by Integra Lifesciences, Corp), Rist Neurovascular, Inc. (Purchased 2020 by Medtronic), Sense Diagnostics, Inc., Serenity Medical, Inc., Silk Road Medical, Sim & Cure, SongBird Therapy, Spinnaker Medical, Inc., StimMed, LLC, Synchron, Inc., Three Rivers Medical, Inc., Truvic Medical, Inc., Tulavi Therapeutics, Inc., Vastrax, LLC, VICIS, Inc., Viseon, Inc. Other financial or non-financial interests: National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE, and SWIFT DIRECT Trials; MicroVention FRED Trial & CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator Trial, COMPASS Trial, INVEST Trial, MIVI neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; InspireMD C-GUARDIANS IDE Pivotal Trial.

Dr Snyder consulting fees: Boston Scientific, Canon Medical Systems USA, Inc., MicroVention, Medtronic, Stryker Neurovascular. Payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing, or educational event: Canon Medical Systems USA Inc. Stock or stock options: Boston Scientific, Access Closure Inc., Niagara Gorge Medical.

All other authors have no personal, financial, or institutional interest in the materials or devices described in this manuscript.

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Soliman, M.A., Khan, A., Azmy, S. et al. Meta-analysis of overall survival and postoperative neurologic deficits after resection or biopsy of butterfly glioblastoma. Neurosurg Rev 45, 3511–3521 (2022). https://doi.org/10.1007/s10143-022-01864-7

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  • DOI: https://doi.org/10.1007/s10143-022-01864-7

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