TY - JOUR
T1 - Impact of intraoperative high-field magnetic resonance imaging guidance on glioma surgery
T2 - A prospective volumetric analysis
AU - Hatiboglu, Mustafa Aziz
AU - Weinberg, Jeffrey S.
AU - Suki, Dima
AU - Rao, Ganesh
AU - Prabhu, Sujit S.
AU - Shah, Komal
AU - Jackson, Ed
AU - Sawaya, Raymond
N1 - Copyright:
Copyright 2009 Elsevier B.V., All rights reserved.
PY - 2009/6
Y1 - 2009/6
N2 - OBJECTIVE: To determine the impact of intraoperative magnetic resonance imaging (iMRI) on the decision to proceed with additional glioma resection during surgery and to maximize extent of resection (EOR). METHODS: Patients who underwent craniotomy for glioma resection with high-field iMRI guidance were prospectively evaluated between September 2006 and August 2007. Volumetric analysis and EOR were assessed with iMRI, using postcontrast T1-weighted images for tumors showing contrast enhancement and T2-weighted images for nonenhancing tumors. RESULTS: Forty-six patients underwent resection using iMRI guidance, with iMRI being used to evaluate the EOR in 44 patients and for reregistration in 2 patients. Surgery was terminated after iMRI in 23 patients (52%) because gross total resection was achieved or because of residual tumor infiltration in an eloquent brain region. Twenty-one patients (47%) underwent additional resection of residual tumor after iMRI. For enhancing gliomas, the median EOR increased significantly from 84% (range, 59%-97%) to 99% (range, 85%-100%) with additional tumor removal after iMRI (P < 0.001). For nonenhancing gliomas, the median EOR increased (from 63% to 80%) with additional tumor removal after iMRI, but not significantly, owing to the small sample size (7 patients). Overall, the EOR increased from 76% (range, 35%-97%) to 96% (range, 48%-100%) (P < 0.001). Gross total resection was achieved after additional tumor removal after iMRI in 15 of 21 patients (71%). Overall, 29 patients (65%) experienced gross total resection, and in 15 (52%), this was achieved with the contribution of iMRI. CONCLUSION: High-field iMRI is a safe and reliable technique, and its use optimizes the extent of glioma resection.
AB - OBJECTIVE: To determine the impact of intraoperative magnetic resonance imaging (iMRI) on the decision to proceed with additional glioma resection during surgery and to maximize extent of resection (EOR). METHODS: Patients who underwent craniotomy for glioma resection with high-field iMRI guidance were prospectively evaluated between September 2006 and August 2007. Volumetric analysis and EOR were assessed with iMRI, using postcontrast T1-weighted images for tumors showing contrast enhancement and T2-weighted images for nonenhancing tumors. RESULTS: Forty-six patients underwent resection using iMRI guidance, with iMRI being used to evaluate the EOR in 44 patients and for reregistration in 2 patients. Surgery was terminated after iMRI in 23 patients (52%) because gross total resection was achieved or because of residual tumor infiltration in an eloquent brain region. Twenty-one patients (47%) underwent additional resection of residual tumor after iMRI. For enhancing gliomas, the median EOR increased significantly from 84% (range, 59%-97%) to 99% (range, 85%-100%) with additional tumor removal after iMRI (P < 0.001). For nonenhancing gliomas, the median EOR increased (from 63% to 80%) with additional tumor removal after iMRI, but not significantly, owing to the small sample size (7 patients). Overall, the EOR increased from 76% (range, 35%-97%) to 96% (range, 48%-100%) (P < 0.001). Gross total resection was achieved after additional tumor removal after iMRI in 15 of 21 patients (71%). Overall, 29 patients (65%) experienced gross total resection, and in 15 (52%), this was achieved with the contribution of iMRI. CONCLUSION: High-field iMRI is a safe and reliable technique, and its use optimizes the extent of glioma resection.
KW - Extent of resection
KW - Glioma surgery
KW - Intraoperative magnetic resonance imaging
KW - Volumetric analysis
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U2 - 10.1227/01.NEU.0000345647.58219.07
DO - 10.1227/01.NEU.0000345647.58219.07
M3 - Article
C2 - 19487886
AN - SCOPUS:68049096100
SN - 0148-396X
VL - 64
SP - 1073
EP - 1081
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -