Abstract
Since the first patients underwent intracranial tumor removal with the radicality control of intraoperative MRI (ioMRI) in September 2005 in our department, the majority of operations performed in the ioMRI room have been indicated for high grade gliomas. In order to elucidate the role of ioMRI scanning in patients harboring high-grade gliomas (HGG) on their survival, one hundred ninety three patients with gliomas WHO grades III and IV were operated either in a standard microsurgical neuronavigated fashion or using additionally ioMRI and were included in a follow-up study. The series started with surgeries from September 2005 until October 2007. Patient attribution to the two groups was based on the logistical availability of the ioMRI on a scheduled surgery day, and on the assumed “difficulty” of the surgery based on the location of the glioma in or near to an eloquent area. Surgery was intended to be as radical as possible without reduction of quality of life.
First surgery was performed in 103 patients (75 WHO IV and 28 WHO III) and will be the main topic of this paper. In 60 patients, ioMRI was used, while in 43 patients standard microsurgical neuronavigated resection techniques were applied.
Patients were followed in regular intervals mostly until death. Statistical analysis showed a median survival time for patients in whom ioMRI had been used of 20, 37 months compared to 10, 3 months in the cohort who had undergone conventional microsurgical removal.
Major influencing concomitants were WHO grades and age which were balanced in both groups.
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Durmaz R, Erken S, Arslantaş A, Atasoy MA, Bal C, Tel E (1997) Management of glioblastoma multiforme: with special reference to recurrence. Clin Neurol Neurosurg 99(2):117–123
Hall WA (2004) Extending survival in gliomas: surgical resection or immunotherapy? Surg Neurol 61(2):145–148
Jeremic B, Grujicic D, Antunovic V, Djuric L, Stojanovic M, Shibamoto Y (1994) Influence of extent of surgery and tumor location on treatment outcome of patients with glioblastoma multiforme treated with combined modality approach. J Neurooncol 21(2):177–185
Knauth M, Wirtz CR, Tronnier VM, Aras N, Kunze S, Sartor K (1999) Intraoperative MR imaging increases the extent of tumor resection in patients with high- grade gliomas. Am J Neuroradiol 20(9):1642–1646
Laws ER, Parney IF, Huang W, Anderson F, Morris AM, Asher A, Lillehei KO, Bernstein M, Brem H, Sloan A, Berger MS, Chang S, Investigators GO (2003) Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project. J Neurosurg 99(3):467–473
Rostomily RC, Spence AM, Duong D, McCormick K, Bland M, Berger MS (1994) Multimodality management of recurrent adult malignant gliomas: results of a phase II multiagent chemotherapy study and analysis of cytoreductive surgery. Neurosurgery 35(3):378–388
Salcman M (1988) Surgical resection of malignant brain tumors: who benefits? Oncology 2(8):47–56
Shinoda J, Sakai N, Murase S, Yano H, Matsuhisa T, Funakoshi T (2001) Selection of eligible patients with supratentorial glioblastoma multiforme for gross total resection. J Neurooncol 52(2):161–171
Stark AM, Nabavi A, Mehdorn HM, Blömer U (2005) Glioblastoma multiforme-report of 267 cases treated at a single institution. Surg Neurol 63(2):162–169
Stark AM, Hedderich J, Held-Feindt J, Mehdorn HM (2007) Glioblastoma–the consequences of advanced patient age on treatment and survival. Neurosurg Rev 30(1):56–66
Vuorinen V, Hinkka S, Färkkilä M, Jääskeläinen J (2003) Debulking or biopsy of malignant glioma in elderly people – a randomised study. Acta Neurochir 145(1):5–10
Yoshida J, Kajita Y, Wakabayashi T, Sugita K (1994) Long-term follow-up results of 175 patients with malignant glioma: importance of radical tumour resection and postoperative adjuvant therapy with interferon, ACNU and radiation. Acta Neurochir 127(1–2):55–59
Claus EB, Horlacher A, Hsu L, Schwartz RB, Dello-Iacono D, Talos F, Jolesz FA, Black PM (2005) Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer 103(6):1227–1233
Fahlbusch R, Ganslandt O, Nimsky C (2000) Intraoperative imaging with open magnetic resonance imaging and neuronavigation. Childs Nerv Syst 16(10–11):829–831
Nimsky C, Ganslandt O, Von Keller B, Romstöck J, Fahlbusch R (2004) Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients. Radiology 233(1):67–78
Hall WA, Martin AJ, Liu H, Pozza CH, Casey SO, Michel E, Nussbaum ES, Maxwell RE, Truwit CL (1998) High-field strength interventional magnetic resonance imaging for pediatric neurosurgery. Pediatr Neurosurg 29(5):253–259
Martin AJ, Hall WA, Liu H, Pozza CH, Michel E, Casey SO, Maxwell RE, Truwit CL (2000) Brain tumor resection: intraoperative monitoring with high-field-strength MR imaging-initial results. Radiology 215(1):221–228
Nabavi A, Dörner L, Stark AM, Mehdorn HM (2009) Intraoperative MRI with 1.5 Tesla in neurosurgery. Neurosurg Clin North Am 20(2):163–171
Wirtz CR, Albert FK, Schwaderer M, Heuer C, Staubert A, Tronnier VM, Knauth M, Kunze S (2000) The benefit of neuronavigation for neurosurgery analyzed by its impact on glioblastoma surgery. Neurol Res 22(4):354–360
Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ, ALA-Glioma Study Group (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 27(5):392–401
Nabavi A, Goebel S, Doerner L, Warneke N, Ulmer S, Mehdorn M (2009) Awake craniotomy and intraoperative magnetic resonance imaging: patient selection, preparation, and technique. Top Magn Reson Imaging 19(4):191–196
Pinsker MO, Nabavi A, Mehdorn HM (2007) Neuronavigation and resection of lesions located in eloquent brain areas under local anesthesia and neuropsychological-neurophysiological monitoring. Minim Invasive Neurosurg 50(5):281–284
Goebel S, Nabavi A, Schubert S, Mehdorn HM (2010) Patient perception of combined awake brain tumour surgery and intraoperative 1.5-T-MRI: The Kiel experience. Neurosurgery
Knauth M, Wirtz CR, Aras N, Sartor K (2001) Low-field interventional MRI in neurosurgery: finding the right dose of contrast medium. Neuroradiology 43(3):254–258
Ulmer S, Helle M, Jansen O, Mehdorn HM, Nabavi A (2009) Intraoperative dynamic susceptibility contrast weighted magnetic resonance imaging (iDSC-MRI) – Technical considerations and feasibility. Neuroimage 45(1):38–43
Nimsky C, Ganslandt O, Cerny S, Hastreiter P, Greiner G, Fahlbusch R (2000) Quantification of, visualization of, and compensation for brain shift using intraoperative magnetic resonance imaging. Neurosurgery 47(5):1070–1079
Oh DS, Black PM (2005) A low-field intraoperative MRI system for glioma surgery: is it worthwhile? Neurosurg Clin N Am 16(1): 135–141, Review
Schneider JP, Trantakis C, Schulz T, Dietrich J, Kahn T (2003) [Intraoperative use of an open mid-field MR scanner in the surgical treatment of cerebral gliomas]. Z Med Phys 13(3): 214–218
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Mehdorn, H.M., Schwartz, F., Dawirs, S., Hedderich, J., Dörner, L., Nabavi, A. (2011). High-Field iMRI in Glioblastoma Surgery: Improvement of Resection Radicality and Survival for the Patient?. In: Pamir, M., Seifert, V., Kiris, T. (eds) Intraoperative Imaging. Acta Neurochirurgica Supplementum, vol 109. Springer, Vienna. https://doi.org/10.1007/978-3-211-99651-5_16
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