Artikel
Extent of resection and surgical morbidity using ultra-low field intraoperative MRI in glioma therapy: a matched pair analysis
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Veröffentlicht: | 28. April 2011 |
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Gliederung
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Objective: The extent of resection in glioma surgery is a prognostic factor. To avoid sensory-motor deficits, neurophysiological monitoring (IOM) is commonly performed. We used a location – matched pair analysis of patients undergoing resections of eloquently located tumors with or without intraoperative MRI (iMRI)-guidance to evaluate beneficial or harmful effects of iMRI.
Methods: Data of 54 consecutive glioma patients undergoing tumor resection with an ultra-low field iMRI (PoleStar, 0.15T) using IOM between January 2007 and December 2009 were prospectively entered into a database. In the same period, 194 glioma patients underwent conventional microsurgical resection with IOM. We then performed a matched pair-analysis comparing the extent of resection and morbidity associated with the surgical procedure. Patients were matched for tumor location, tumor size, and contrast behaviour on high field MRI scans.
Results: 18 pairs of patients could be analyzed. There were 16 patients with contrast enhancing and 2 with non-enhancing tumors in each group. According to early postoperative high-field MRI (<48h), a complete resection was achieved in 15 patients (83.3%) in the iMRI group vs.10 patients (55.6%) in the control group (P=0.07). Using iMRI had led to continued resection in 8 patients (44.4%). 3 patients (16.7%) in the iMRI group and 2 patients (11.1%) in the control group showed a new neurological deficit (P=1.0). 6 patients in the iMRI group (33.3%) and 1 patient (5.6%) in the control group showed a transient aggravation of a pre-existing deficit (P<0.05), which all improved within a few days following surgery. There were no permanent disabling deficits in either group (P=1.0).
Conclusions: Using iMRI-guidance in combination with IOM techniques tends to enable higher rates of complete tumor resection in gliomas than conventional microsurgery. Although using iMRI might lead to a transient aggravation of pre-existing sensory-motor deficits, there is no higher risk for new permanent deficits or morbidity compared to conventional microsurgery.