Intraoperative Magnetic Resonance Imaging in Brain Glioma Surgery Using Low-field system. Presentation of the First Twenty-eight Procedures
Main Article Content
Abstract
Background: Imaging systems placed into the operating theatre is becoming a standard practice in glioma resection surgery.
Aim: To evaluate feasibility, safety, and utility of an intraoperative open low-field magnetic resonance imaging (iMRI) to assess the extent of glioma resection.
Methods: Study population sample included 28 patients undergoing first time surgical resection for brain gliomas. All patients underwent preoperative and postoperative high-field MRI scans, and one to four intraoperative MRI acquisitions, using a side-opening 0.25 T MRI system. Pre- and postoperative MRI scans were assessed to measure volumetric changes and the extent of resection. Surgical timing was also registered.
Results: n=28 patients (19 men and 9 women, range: 6 - 71 years), underwent microsurgical resection of brain glioma for the first time (18 high-grade and 10 low-grade gliomas). Postoperative MRI indicated that gross total resection (>99%) was achieved in 23/28 (82%), subtotal resection (90-99%) in 4/28 (14%) patients; in the latter, residual tumor volume ranges between 0.5 and 8.2 cm3; and partial resection (<90%) in 1/28 (4%). Three patients (10.7%) experienced worsening of neurological symptoms (only one permanent). The average time required for each imaging session was 12 minutes.
Conclusion and Relevance: Intraoperative low-field MRI-guided resections maximizes the extent of glioma resections, without significant interferences with surgical and anesthesiologic procedures and without excessive prolongation of the surgery, playing a relevant role in patient survival and quality of life.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Noh T, Mustroph M, Golby AJ. Intraoperative Imaging for High-Grade Glioma Surgery. Neurosurg Clin N Am. 2021;32(1):47-54. https://doi.org/10.1016/j.nec.2020.09.003
3. Smith JS, Chang EF, Lamborn KR, et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol. 2008;26(8):1338-1345. https://doi.org/10.1200/JCO.2007.13.9337
4. Lacroix M, Abi-Said D, Fourney DR, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001;95(2):190-198. https://doi.org/10.3171/jns.2001.95.2.0190
5. Correa-Arana K, Vivas-Albán OA, Sabater-Navarro JM. Neurosurgery and brain shift: review of the state of the art and main contributions of robotics. TecnoLógicas. 2017;20(40):125-138. http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0123-77992017000300010
6. Kuhnt D, Bauer MH, Nimsky C. Brain shift compensation and neurosurgical image fusion using intraoperative MRI: current status and future challenges. Crit Rev Biomed Eng. 2012;40(3):175-185. https://doi.org/10.1615/critrevbiomedeng.v40.i3.20
7. Matsumae M, Nishiyama J, Kuroda K. Intraoperative MR Imaging during Glioma Resection. Magn Reson Med Sci. 2022;21 (1):148-167. https://doi.org/10.2463/mrms.rev.2021-0116
8. Šteňo A, Buvala J, Babková V, Kiss A, Toma D, Lysak A. Current Limitations of Intraoperative Ultrasound in Brain Tumor Surgery. Front Oncol. 2021;11:659048. https://doi.org/10.3389/fonc.2021.659048
9. Dixon L, Lim A, Grech-Sollars M, Nandi D, Camp S. Intraoperative ultrasound in brain tumor surgery: A review and implementation guide. Neurosurg Rev. 2022;45(4):2503-2515. https://doi.org/10.1007/s10143-022-01778-4
10. Rogers CM, Jones PS, Weinberg JS. Intraoperative MRI for Brain Tumors. J Neurooncol. 2021;151(3):479-490.
https://doi.org/10.1007/s11060-020-03667-6
11. Alvarez-Linera J. 3T MRI: advances in brain imaging. Eur J Radiol. 2008:67(3):415-426 https://doi.org/10.1016/j.ejrad.2008.02.045
12. Ladd ME, Bachert P, Meyerspeer M, et al. Pros and cons of ultra-high-field MRI/MRS for human application. Prog Nucl Magn Reson Spectrosc. 2018;109:1-50. https://doi.org/10.1016/j.pnmrs.2018.06.001
13. Schulder M, Carmel PW. Intraoperative magnetic resonance imaging: impact on brain tumor surgery. Cancer Control. 2003;10(2): 115-124. https://doi:10.1177/107327480301000203
14. Senft C, Bink A, Franz K, Vatter H, Gasser T, Seifert V. Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol. 2011;12(11):997-1003. https://doi.org/10.1016/S1470-2045(11)70196-6
15. Brambrink AM, Orfanakis A, Kirsch JR. Anesthetic neurotoxicity. Anesthesiol Clin. 2012;30(2):207-228. https://doi.org/10.1016/j.anclin.2012.06.002
16. Routh JC, Bacon DR, Leibovich BC, Zincke H, Blute ML, Frank I. How long is too long? The effect of the duration of anaesthesia on the incidence of non-urological complications after surgery. BJU Int. 2008;102(3):301-304. https://doi.org/10.1111/j.1464-410X.2008.07663.x
17. Cheng H, Clymer JW, Po-Han Chen B, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res. 2018;229:134-144. https://doi.org/10.1016/j.jss.2018.03.022
18. Arnold TC, Freeman CW, Litt B, Stein JM. Low-field MRI: Clinical promise and challenges. J Magn Reson Imaging. 2023;57(1):25-44. https://doi.org/10.1002/jmri.28408
19. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021;23(8):1231-1251. https://doi.org/10.1093/neuonc/noab106
20. Staubert A, Pastyr O, Echner G, et al. An integrated head-holder/coil for intraoperative MRI in open neurosurgery. J Magn Reson Imaging. 2000;11(5):564-567.
https://doi.org/10.1002/(sici)1522-2586(200005)11:5<564::aid-jmri13>3.0.co;2-n
21. Péus D, Newcomb N, Hofer S. Appraisal of the Karnofsky Performance Status and proposal of a simple algorithmic system for its evaluation. BMC Med Inform Decis Mak. 2013;13:72. https://doi.org/10.1186/1472-6947-13-72
22. Chang SM, Parney IF, McDermott M, et al. Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg. 2003;98(6):11 75-1181. https://doi.org/10.3171/jns.2003.98.6.1175
23. Wirtz CR, Knauth M, Staubert A, et al. Clinical evaluation and follow-up results for intraoperative magnetic resonance imaging in neurosurgery. Neurosurgery. 2000;46(5):1112 -1122. https://doi.org/10.1097/00006123-200005000-00017
24. Roder C, Bisdas S, Ebner FH, et al. Maximizing the extent of resection and survival benefit of patients in glioblastoma surgery: high-field iMRI versus conventional and 5-ALA-assisted surgery. Eur J Surg Oncol. 2014;40(3):297-304. https://doi.org/10.1016/j.ejso.2013.11.022