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Updated: May 25, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Use of intraoperative MRI for resection of gliomas
Hector Navarro Cabrera1, Antonio Nogueira de Almeida, Clemar Corrêa da Silva
1Department of Functional Neurosurgery, Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Unlabelled:
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.
Insights
Intraoperative MRI aids glioma removal, improving patient outcomes. However, surgeons must still rely on anatomical knowledge to prevent complications and ensure safety during tumor resection.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Extent of tumor resection significantly impacts glioma patient survival and quality of life.
- Intraoperative MRI (iMRI) is utilized to enhance tumor resection while maintaining procedural safety.
Purpose of the Study:
- To report the initial experience with iMRI in glioma surgery.
- To evaluate the effectiveness and safety of iMRI in achieving maximal safe tumor resection.
Main Methods:
- Case series of the first five patients undergoing glioma surgery with iMRI at the University of São Paulo.
- Patients generally presented with high Karnofsky Performance Status (100% in four out of five).
- Presenting symptoms included headache, seizures, behavioral changes, hemianopsia, and hemiparesis.
Main Results:
- Complete gross total tumor removal was achieved in two patients.
- Resection was limited in the remaining patients due to tumor infiltration into critical brain structures (internal capsule, mesencephalon).
Conclusions:
- Intraoperative MRI is a valuable tool for improving glial tumor resection.
- Fundamental knowledge of neurophysiology and functional anatomy remains critical for minimizing patient morbidity during surgery.
