Feasibility of Intraoperative MRI Guidance for Craniotomy and Tumor Resection in the Semisitting Position

Abstract BACKGROUND Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative MRI (iMRI) in the resection of grade II gliomas. We assessed the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly-diagnosed grade II astrocytomas and oligodendrogliomas. METHODS Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS/PFS. RESULTS 232 resections (112 astrocytomas, 120 oligodendrogliomas; 135 males; mean age 36.2 ± 0.9 years) were analyzed. Oligodendrogliomas had longer OS (p< 0.001) and PFS (p=0.009) than astrocytomas. Multivariate regression showed that extent of resection (EOR), including gross-total (GTR) versus near-total (NTR) resection (p=0.02, HR: 0.64, 95% CI: 0.25-.79) and GTR versus subtotal resection (STR) (p=0.006, HR: 0.23, 95% CI: 0.08-0.66), was associated with longer OS. GTR versus NTR (p=0.04, HR: 0.49, 95% CI: 0.29-.85), GTR versus STR (p=0.02, HR: .54, 95% CI: .32-.91) and iMRI use (p=0.02, HR: 0.54, 95% CI: 0.32-0.92) were associated with longer PFS. Frontal (p=0.048, HR: 2.11, 95% CI: 1.01-4.43) and occipital/parietal (p=0.003, HR: 3.59, 95% CI: 1.52-8.49) locations were associated with shorter PFS (versus temporal). Kaplan-Meier analyses showed longer OS with increasing EOR (p=0.03) and 1p/19q gene deletions (p=0.02). PFS improved with increasing EOR (p=0.01), GTR versus NTR (p=0.02), and resections above STR (p=0.04). Factors influencing adjuvant treatment (35.3% of patients) included age (p=0.002, OR: 1.04) and EOR (p=0.037, OR: 0.41 for NTR versus STR; p=0.003, OR: 0.39 for GTR versus STR), but not glioma subtype or location, as determined by logistic regression. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these cases. CONCLUSIONS EOR significantly improves OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.

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Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field intraoperative MRI guidance

Neuro-Oncology ◽

10.1093/neuonc/nor133 ◽

2011 ◽

Vol 13 (12) ◽

pp. 1339-1348 ◽

Cited By ~ 166

Author(s):

D. Kuhnt ◽

A. Becker ◽

O. Ganslandt ◽

M. Bauer ◽

M. Buchfelder ◽

...

Keyword(s):

Glioblastoma Multiforme ◽

High Field ◽

Tumor Volume ◽

Patient Survival ◽

Intraoperative Mri ◽

Mri Guidance

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Use of intraoperative MRI for resection of gliomas

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2011000700020 ◽

2011 ◽

Vol 69 (6) ◽

pp. 949-953 ◽

Cited By ~ 3

Author(s):

Hector Navarro Cabrera ◽

Antonio Nogueira de Almeida ◽

Clemar Corrêa da Silva ◽

Erich Talamoni Fonoff ◽

Maria das Graças Martin ◽

...

Keyword(s):

Karnofsky Performance Status ◽

Performance Status ◽

Tumor Resection ◽

Functional Anatomy ◽

Internal Capsule ◽

Intraoperative Mri ◽

Critical Areas ◽

Behavior Disturbance ◽

The University

Literature has shown that extent of tumor resection has an impact on quality of life and survival of patients with gliomas. Intraoperative MRI has been used to increase resection while preserving procedure's safety. METHOD: The first five patients with gliomas operated on at the University of São Paulo using intraoperative MRI are reported. All but one patient had Karnofsky Performance Status of 100% before surgery. Presentation symptoms were progressive headache, seizures, behavior disturbance, one instance of hemianopsia, and another of hemiparesis. RESULTS: Gross total removal was achieved in two patients. Surgical resection was limited by tumor invasion of critical areas like the internal capsule or the mesencephalon in the remaining patients. CONCLUSION: Intra-operative MRI is an important tool that helps surgeons to remove glial tumors, however, knowledge of physiology and functional anatomy is still fundamental to avoid morbidity.

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Ten years’ experience with intraoperative MRI-assisted transsphenoidal pituitary surgery

Neurosurgical FOCUS ◽

10.3171/2020.3.focus2072 ◽

2020 ◽

Vol 48 (6) ◽

pp. E14

Author(s):

Michal Hlaváč ◽

Andreas Knoll ◽

Benjamin Mayer ◽

Michael Braun ◽

Georg Karpel-Massler ◽

...

Keyword(s):

Pituitary Adenomas ◽

Cox Regression ◽

Tumor Resection ◽

Residual Tumor ◽

Pituitary Surgery ◽

Intraoperative Mri ◽

Target Tissue ◽

Cox Regression Analysis ◽

Transsphenoidal Pituitary Surgery ◽

Additional Resection

OBJECTIVEMany innovations have been introduced into pituitary surgery in the quest to maximize the extent of tumor resection. Because of the deep and narrow surgical corridor as well as the heterogeneity of confronted pathologies, anatomical orientation and identification of the target tissue can become difficult. Intraoperative MRI (iMRI) may have the potential to increase extent of resection (EOR) in transsphenoidal pituitary surgery. Furthermore, it may simplify anatomical orientation and risk assessment in difficult cases. Here, the authors evaluated the additional value of iMRI for the resection of pituitary adenomas performed in the past 10 years in their department.METHODSThey performed a retrospective single-center analysis of patients treated for pituitary adenoma in their department after the introduction of iMRI between 2008 and 2018. Of 495 transsphenoidal approaches, 300 consecutive MRI-assisted surgeries for pituitary adenomas encompassing 294 patients were selected for further analysis. Microscopic, endoscopic, or endoscope-assisted microscopic transsphenoidal approaches were distinguished. EOR as well as additional resection following iMRI was evaluated via detailed volumetric analysis. Patients were stratified according to the Knosp adenoma classification. Furthermore, demographic data, clinical symptoms, endocrine outcome, and complications were evaluated. Univariable and multivariable Cox regression analyses of progression-free survival (PFS) were performed.RESULTSPituitary adenomas classified as Knosp grades 0–2 were found in 60.3% of cases (n = 181). The most common tumors were nonfunctioning adenomas (75%). Continued resection following iMRI significantly increased EOR (7.5%, p < 0.001) and the proportion of gross-total resections (GTRs) in transsphenoidal pituitary surgery (54% vs 68.3%, p < 0.001). Additional resection after iMRI was performed in 37% of cases. Only in the subgroup of patients with Knosp grades 0–2 adenomas treated with the microsurgical technique was additional resection significantly more common than in the endoscopic group (p = 0.039). Residual tumor volume, Knosp grade, and age were confirmed as independent predictors of PFS (p < 0.001, p = 0.021, and p = 0.029, respectively) in a multivariable Cox regression analysis. Improvement of visual field deficits was documented in 78.6% of patients whose optic apparatus had been affected preoperatively. Revision surgery was done in 7.3% of cases; in 5.6% of cases, it was performed for cerebrospinal fluid fistula.CONCLUSIONSIn this series, iMRI led to the detection of a resectable tumor remnant in a high proportion of patients, resulting in a greater EOR and higher proportion of GTRs after continued resection in microsurgical and endoscopic transsphenoidal resection of pituitary adenomas. The volume of residual tumor was the most important predictor of PFS. Given the study data, the authors postulated that every bit of removed tumor serves the patient and increases their chances of a favorable outcome.

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Combined Brain Mapping and Compact Intraoperative MRI for Brain Tumor Resection

Stereotactic and Functional Neurosurgery ◽

10.1159/000488991 ◽

2018 ◽

Vol 96 (3) ◽

pp. 172-181

Author(s):

Timothy White ◽

Salvatore Zavarella ◽

Lauren Jarchin ◽

Dominic Nardi ◽

Sarah Schaffer ◽

...

Keyword(s):

Brain Tumor ◽

Brain Mapping ◽

Tumor Resection ◽

Intraoperative Mri ◽

Brain Tumor Resection

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Intraoperative MRI Features of Absorbable Oxidized Regenerated Cellulose During Cerebral Glioma Surgery

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v24i1.1269 ◽

2018 ◽

Vol 24 (1) ◽

pp. 16-20

Author(s):

Ricardo Ramina ◽

Maurício Coelho Neto ◽

Alessandra B. Nascimento ◽

Ronaldo Vosgerau

Keyword(s):

Tumor Resection ◽

Intraoperative Mri ◽

Regenerated Cellulose ◽

Low Grade ◽

Oxidized Regenerated Cellulose ◽

Glioma Surgery ◽

Hyperintense Signal ◽

Mri Features ◽

Cerebral Gliomas ◽

Resection Borders

Objectives: Foreign body reaction to absorbable hemostatic agents may mimick recurrent brain tumor or abscess on postoperative MRI. Their appearance on intraoperative MRI and their use as resection borders marker have been not previously described. This study evaluates the intraoperative MRI appearance of absorbable oxidized regenerated cellulose in surgery of cerebralgliomas. Methods: 72 patients with cerebral gliomas were intraoperatively examined with high field MRI (1.5 T). 32 patients presented low-grade and 40 high-grade gliomas. After tumor resection the tumor bed was covered with absorbable oxidized regenerated cellulose. Results: The absorbable hemostat presented a hyperintense signal on MRI-T1 sequences in all patients. Tumor remnants under the hemostatic agent could be identified. Conclusions: Oxidized Regenerated Cellulose can be easily observed as a hyperintense signal lining covering the borders of the surgical cavity on intraoperative MRI-T1 sequences. It may be a useful marker of tumor resection borders of cerebral gliomas.

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