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Published on: August 12, 2019
Intraoperative MRI for the management of brain lesions adjacent to eloquent areas
N Reyns1, H-A Leroy2, C Delmaire3
1Inserm U1189, Onco-Thai - Image Assisted Laser Therapy for Oncology, University of Lille, 59000 Lille, France; Department of Neurosurgery, CHU de Lille, 59000 Lille, France.
Background:
The aim of our study was to report the usefulness of intraoperative MRI guidance in the resection of brain lesions adjacent to eloquent areas.
Patients And Methods:
A single center prospective series of gliomas amenable to optimized resection with intraoperative MRI between September 2014 and December 2015.
Results:
The study included 56 patients. The median duration of the first intraoperative MRI was 38min, interquartile range (IQR 30-46). Fourteen patients (40%) underwent a second intraoperative MRI, which had a median duration of 26min (IQR, 18-30). The median total operative time was 265min (IQR, 242-337). After the first intraoperative MRI, the median residual glioma volume of the 35 gliomas adjacent to eloquent areas was 7.04cm3 (IQR, 2.22-13.8), which did not significantly differ from the other gliomas (P=0.07). After the second intraoperative MRI, the median residual glioma volume was 3.86cm3 (IQR, 0.82-6.99), which did not significantly differ from the other patients (P=0.700). On the postoperative MRI, the median extent of the glioma resections adjacent to eloquent areas was 99.78% (IQR, 88.9-100), which was not significantly different from the rest of the population (P=0.290). At 6 months after surgery, the median Karnofsky Performance Score was 90, and 2.8% of the patients presented a permanent new neurological deficit.
Conclusion:
Our results suggest that intraoperative MRI is an effective and safe technique to improve the extent of brain lesion resections close to eloquent areas.
Insights
Intraoperative MRI guidance enhances brain lesion resection near critical areas. This safe technique improves tumor removal extent, leading to better patient outcomes and minimal new neurological deficits.
Area of Science:
- Neurosurgery
- Neuroradiology
- Oncology
Background:
- Brain lesions adjacent to eloquent areas pose significant surgical challenges.
- Optimizing resection in these regions is crucial for preserving neurological function.
Purpose of the Study:
- To evaluate the effectiveness of intraoperative MRI (iMRI) guidance for brain lesion resection near eloquent areas.
- To assess the impact of iMRI on resection extent and patient outcomes.
Main Methods:
- Prospective study of 56 patients with gliomas undergoing surgery with iMRI guidance.
- Analysis of residual tumor volume and extent of resection based on iMRI findings.
- Assessment of neurological deficits and functional status at 6 months post-surgery.
Main Results:
- iMRI guidance, including repeat scans, was utilized in 40% of patients.
- Post-iMRI, residual glioma volume in eloquent areas was comparable to non-eloquent areas.
- High resection rates (median 99.78%) were achieved in eloquent areas with no significant difference compared to other gliomas.
Conclusions:
- Intraoperative MRI is a valuable tool for maximizing brain lesion resection near eloquent areas.
- The technique is safe and contributes to improved extent of resection without increasing neurological deficits.
