Navigating Brain Metastases: Unveiling the Potential of 3-Tesla Intraoperative Magnetic Resonance Imaging

Area of Science:

• Neurosurgery
• Oncology
• Radiology

Background:

• Intraoperative magnetic resonance imaging (iMRI) is established in glioma surgery for neuronavigation and optimizing extent of resection (EOR).
• The utility of iMRI in resecting brain metastases (BMs) has not been extensively studied.

Purpose of the Study:

• To evaluate the effect of 3-Tesla iMRI on the resection of brain metastases (BMs).
• To assess the safety, feasibility, and impact of iMRI on gross total resection (GTR) rates and patient outcomes in BM surgery.

Main Methods:

• Retrospective analysis of 25 patients with BMs undergoing resection with 3-Tesla iMRI (2018-2022).
• Volumetric measurements of resected contrast-enhancing metastases using preoperative, intraoperative, and postoperative MRI.
• Assessment of Karnofsky Performance Score (KPS) and neurological status pre- and postoperatively.
• Evaluation of local recurrence and in-brain progression via follow-up MRI at 3 and 6 months.

Main Results:

• Gross total resection (GTR) was achieved in 84% of patients (21/25).
• iMRI guided further resection in 24% of cases (6/25), improving EOR to 100% in five cases.
• Postoperative neurological status remained stable in 60% of patients.
• No wound healing or acute postoperative complications were observed.

Conclusions:

• Intraoperative MRI is a safe and feasible tool for brain metastases resection, enhancing the extent of resection and aiding precise tumor delineation.
• The use of iMRI in BM surgery demonstrated favorable GTR rates and an absence of complications, supporting its integration into neurosurgical workflows.
• Larger prospective studies are warranted to establish specific indications for iMRI in BMs and to investigate its impact on patient survival.