gms | German Medical Science

Objective: To investigate the contribution of high-field intraoperative magnetic resonance imaging (iMRI) and navigation with integrated functional image data on the amount of resected tumor volume in glioblastoma-surgery.

Methods: We investigated 135 patients with supratentorial glioblastoma multiforme (WHO grade IV), who underwent glioma surgery with 1.5 Tesla iMRI. Quantitative analysis and volumetric assessment were performed in pre- and intraoperative MR-images and evaluated retrospectively.

Results: The surgical procedure was influenced by iMRI in 14.1% (19 patients). Subgroups were evaluated for the percentage of resected tumor-volume: 99.9– 98%: 0 patients, 97.9–95%: 3 patients, 94.9–90%: 1 patient and less than 90%: 15 patients. Further resection led to gross-total resection in 9 patients, resected tumor-volume of 99.9–98% in 1 patient, 97.9–95% in 0 patients, 94.9–90% in 1 patient and less than 90% in 8 patients. In 116 cases, further resection was abstained because of either initially achieved gross-total resection or adjacence to eloquent brain areas. Complete resection was here achieved in 47 patients (resection rate 99.9–98%: 3 patients, 97.9–95%: 2 patients, 94.9–90%: 11 patients and less than 90%: 53 patients). Thus, the rate of gross-total resection could be increased from 34.8% (47 patients) to 41.5% (56 patients). Volumetric assessment showed that the overall tumor volume could be significantly reduced after iMRI and continued surgery from 34.3%±23.7% (9.9±20.9 cm³) vs 1.2%±16.2% (0.3±15.9 cm³), p<0.01.

Conclusions: Intraoperative high-field MRI significantly improved tumor-volume resection in surgery of glioblastoma multiforme (WHO grade IV) supported by quantitative analysis and assessment of tumor-volume in 135 cases.