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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.