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Glioma surgery evaluated by intraoperative low-field magnetic resonance imaging
C Nimsky1, O Ganslandt, M Buchfelder
1Department of Neurosurgery, University Erlangen-Nürnberg, Erlangen, Germany.
Objective:
To give an overview on intraoperative magnetic resonance (MR) imaging in glioma surgery.
Material And Methods:
MR imaging was performed using a 0.2T scanner, located in a radiofrequency-shielded operating theatre. Two setups were used: surgery either in a neighbouring operating theatre, or directly at the 5G line. Additionally, in gliomas adjacent to eloquent brain areas microscope- or pointer-based neuronavigation with integrated functional data was applied. 106 gliomas were among the 330 patients investigated in the last 5 years.
Results:
We did not observe complications attributable to intraoperative MR imaging. Image quality was sufficient to evaluate the extent of the tumour resection in the majority of cases. Intraoperative imaging revealed remaining tumour in 63%. In a total of 26% patients further tumour could be removed due to the results of intraoperative imaging, increasing the rate of complete tumour removal especially in the low-grade tumours. The additional use of functional neuronavigation prevented an increased morbidity.
Conclusion:
Intraoperative MR imaging offers the possibility of further tumour removal during the same surgical procedure in case of tumour remnants, increasing the rate of complete tumour removal. The effects of brain shift can be compensated for using intraoperative image data for updating.
Insights
Intraoperative magnetic resonance (MR) imaging aids glioma surgery by identifying residual tumors, enabling further resection and increasing complete tumor removal rates. This technology helps surgeons manage brain shift effectively.
Area of Science:
- Neurosurgery
- Medical Imaging
- Oncology
Background:
- Glioma surgery aims for maximal tumor removal while preserving neurological function.
- Brain shift during surgery can lead to incomplete resection.
- Intraoperative imaging is crucial for real-time surgical guidance.
Purpose of the Study:
- To evaluate the utility of intraoperative magnetic resonance (MR) imaging in glioma surgery.
- To assess the impact of intraoperative MR imaging on tumor resection rates and patient outcomes.
- To investigate the role of functional neuronavigation in minimizing morbidity.
Main Methods:
- Intraoperative MR imaging was performed using a 0.2T scanner in a shielded operating theatre.
- Two imaging setups were utilized: surgery in an adjacent theatre or directly at the 5G line.
- Functional neuronavigation was employed for gliomas near eloquent brain areas.
Main Results:
- No complications were attributed to intraoperative MR imaging.
- Image quality was sufficient for assessing tumor resection extent in most cases.
- Intraoperative imaging identified residual tumor in 63% of patients, leading to further resection in 26% and increasing complete tumor removal rates, particularly for low-grade gliomas.
Conclusions:
- Intraoperative MR imaging facilitates additional tumor removal during surgery for residual gliomas.
- This technique enhances the rate of complete tumor removal.
- Intraoperative imaging data can be used to update surgical plans and compensate for brain shift, preventing increased morbidity when combined with functional neuronavigation.