Article
Impact of intraoperative high-field MRI and functional neuronavigation on supratentorial glioma resection
Einfluss der intraoperativen Hochfeld-MR-Bildgebung und der funktionellen Neuronavigation auf die Resektion von supratentoriellen Gliomen
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Published: | May 8, 2006 |
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Objective: To investigate how functional neuronavigation and intraoperative high-field magnetic resonance imaging (MRI) influence glioma resection.
Methods: 137 patients (WHO grade I: 20; II: 19; III: 41; IV: 57) underwent resection for supratentorial gliomas in an operative suite equipped with an intraoperative high-field MRI and microscope-based neuronavigation. Besides standard anatomical image data including T1- and T2-weighted sequences, various functional data from magnetoencephalography (n=37), functional MRI (n=65), positron emission tomography (n=8), MR spectroscopy (n=28) and diffusion tensor imaging (n=55) were integrated in the navigational setup.
Results: Intraoperative MRI showed primary complete resection in 27% of all patients (I: 50%; II: 53%; III: 2%; IV: 28%). In 41% of all patients (I: 40%; II: 26%; III: 66%; IV: 28%) the resection was extended due to intraoperative MRI increasing the percentage of complete resections to 40% (I: 70%; II: 58%; III: 17%; IV: 40%). Integrated application of functional navigation resulted in low postoperative morbidity with a transient new neurological deficit in 10.2% (paresis: 8.8%, speech disturbance: 1.4%) decreasing to a permanent deficit in 2.9% (4 of 137 patients with a new or worsened paresis).
Conclusions: The combination of intraoperative MRI and functional navigation allows safe extended resections in glioma surgery. However, despite extended resections, in the majority of the grade III and IV gliomas, still no gross total resection could be achieved due to the extension of the tumor into eloquent brain areas. Intraoperative MRI data can be used to localize the tumor remnants reliably and compensate for the effects of brain shift.