Pieter L Kubben

Publications (12)17.26 Total impact

• Article: Intraoperative magnetic resonance imaging for high grade glioma resection: Evidence-based or wishful thinking?

  Pieter L Kubben, Henk van Santbrink
  Surgical neurology international. 01/2013; 4:1.
• Article: Correlation between contrast enhancement on intraoperative magnetic resonance imaging and histopathology in glioblastoma.

  Pieter L Kubben, Pieter Wesseling, Martin Lammens, Olaf E M G Schijns, Mariël P Ter Laak-Poort, Jacobus J van Overbeeke, Henk van Santbrink
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  ABSTRACT: OBJECT: Glioblastoma is a highly malignant brain tumor, for which standard treatment consists of surgery, radiotherapy, and chemotherapy. Increasing extent of tumor resection (EOTR) is associated with prolonged survival. Intraoperative magnetic resonance imaging (iMRI) is used to increase EOTR, based on contrast enhanced MR images. The correlation between intraoperative contrast enhancement and tumor has not been studied systematically. METHODS: For this prospective cohort study, we recruited 10 patients with a supratentorial brain tumor suspect for a glioblastoma. After initial resection, a 0.15 Tesla iMRI scan was made and neuronavigation-guided biopsies were taken from the border of the resection cavity. Scores for gadolinium-based contrast enhancement on iMRI and for tissue characteristics in histological slides of the biopsies were used to calculate correlations (expressed in Kendall's tau). RESULTS: A total of 39 biopsy samples was available for further analysis. Contrast enhancement was significantly correlated with World Health Organization (WHO) grade (tau 0.50), vascular changes (tau 0.53), necrosis (tau 0.49), and increased cellularity (tau 0.26). Specificity of enhancement patterns scored as "thick linear" and "tumor-like" for detection of (high grade) tumor was 1, but decreased to circa 0.75 if "thin linear" enhancement was included. Sensitivity for both enhancement patterns varied around 0.39-0.48 and 0.61-0.70, respectively. CONCLUSIONS: Presence of intraoperative contrast enhancement is a good predictor for presence of tumor, but absence of contrast enhancement is a bad predictor for absence of tumor. The use of gadolinium-based contrast enhancement on iMRI to maximize glioblastoma resection should be evaluated against other methods to increase resection, like new contrast agents, other imaging modalities, and "functional neurooncology" - an approach to achieve surgical resection guided by functional rather than oncological-anatomical boundaries.
  Surgical neurology international. 01/2012; 3:158.
• Article: Intraoperative MRI-guided resection of glioblastoma multiforme: a systematic review.

  Pieter L Kubben, Karlien J ter Meulen, Olaf E M G Schijns, Mariël P ter Laak-Poort, Jacobus J van Overbeeke, Henk van Santbrink
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  ABSTRACT: We did a systematic review to address the added value of intraoperative MRI (iMRI)-guided resection of glioblastoma multiforme compared with conventional neuronavigation-guided resection, with respect to extent of tumour resection (EOTR), quality of life, and survival. 12 non-randomised cohort studies matched all selection criteria and were used for qualitative synthesis. Most of the studies included descriptive statistics of patient populations of mixed pathology, and iMRI systems of varying field strengths between 0·15 and 1·5 Tesla. Most studies provided information on EOTR, but did not always mention how iMRI affected the surgical strategy. Only a few studies included information on quality of life or survival for subpopulations with glioblastoma multiforme or high-grade glioma. Several limitations and sources of bias were apparent, which affected the conclusions drawn and might have led to overestimation of the added value of iMRI-guided surgery for resection of glioblastoma multiforme. Based on the available literature, there is, at best, level 2 evidence that iMRI-guided surgery is more effective than conventional neuronavigation-guided surgery in increasing EOTR, enhancing quality of life, or prolonging survival after resection of glioblastoma multiforme.
  The lancet oncology 08/2011; 12(11):1062-70. · 14.47 Impact Factor
• Article: Twitter for neurosurgeons.

  Pieter L Kubben
  Surgical neurology international. 01/2011; 2:28.
• Article: QR codes in neurosurgery.

  Pieter L Kubben
  Surgical neurology international. 01/2011; 2:104.
• Article: Intraobserver and interobserver agreement in volumetric assessment of glioblastoma multiforme resection.

  Pieter L Kubben, Alida A Postma, Alfons G H Kessels, Jacobus J van Overbeeke, Henk van Santbrink
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  ABSTRACT: The role of extent of tumor resection in improving outcome for patients with glioblastoma multiforme (GBM) is still under debate. To analyze intraobserver and interobserver agreement of manual segmentation as a method for volumetric assessment of GBM resection. Three observers performed volumetric assessment of preoperative tumor volume (PreTV) and postoperative tumor volume (PostTV) by manual segmentation on contrast-enhanced T1-weighted MRI data sets of 8 patients. Measurements were repeated after a minimum interval of 2 weeks. Intraobserver and interobserver agreement for PreTV, PostTV, and residual tumor volume (RTV) percentage were expressed in intraclass correlation coefficients (ICCs). Intraobserver agreement is high for PreTV (ICC = 0.99), PostTV (ICC = 0.73-0.94), and RTV (ICC = 0.89-0.94). Interobserver agreement is high for PreTV (ICC = 0.97), but low for PostTV (ICC = 0.54) and RTV (ICC = 0.52). Postoperative assessment of GBM volume seems to offer high intraobserver agreement, but low interobserver agreement. Using absolute RTV values to relate extent of tumor resection with survival may be unreliable. More research is needed before this method can be used as a valid end point for clinical studies. Computer-assisted tumor volume calculation may increase interobserver agreement in the future.
  Neurosurgery 11/2010; 67(5):1329-34. · 2.79 Impact Factor
• Article: A free forum for neurosurgery and neuroscience.

  Pieter L Kubben
  Surgical neurology international. 01/2010; 1.
• Article: Introducing neurosurgery 2.0.

  Pieter L Kubben
  Surgical neurology international. 01/2010; 1:8.
• Article: Neurosurgical apps for iPhone, iPod Touch, iPad and Android.

  Pieter L Kubben
  Surgical neurology international. 01/2010; 1:89.
• Article: What every neurosurgeon should know about the Web 2.0.

  Pieter L Kubben
  Surgical neurology international. 01/2010; 1.
• Article: Neurosurgical videos going mobile.

  Pieter L Kubben
  Surgical neurology international. 01/2010; 1:67.
• Article: Neurosurgical content for mobile devices.

  Pieter L Kubben
  Surgical neurology international. 01/2010; 1:46.