Impact of intraoperative high-field magnetic resonance imaging guidance on glioma surgery: a prospective volumetric analysis

Mustafa Aziz Hatiboglu, Jeffrey S Weinberg, Dima Suki, Ganesh Rao, Sujit S Prabhu, Komal Shah, Ed Jackson, Raymond Sawaya
Neurosurgery 2009, 64 (6): 1073-81; discussion 1081

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.

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