gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

A prospective randomized trial on intraoperative MRI-guided vs. conventional microsurgical resection of gliomas

Meeting Abstract

  • C. Senft - Klinik für Neurochirurgie, Goethe-Universität, Frankfurt
  • A. Bink - Institut für Neuroradiologie, Goethe-Universität, Frankfurt
  • K. Franz - Klinik für Neurochirurgie, Goethe-Universität, Frankfurt
  • T. Gasser - Klinik für Neurochirurgie, Goethe-Universität, Frankfurt; Klinik für Neurochirurgie, Universität Duisburg-Essen, Essen
  • V. Seifert - Klinik für Neurochirurgie, Goethe-Universität, Frankfurt

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.04.04

DOI: 10.3205/11dgnc012, URN: urn:nbn:de:0183-11dgnc0123

Published: April 28, 2011

© 2011 Senft et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Our aim was to present a scientifically sound basis for the use of intraoperative MRI (iMRI) in glioma surgery.

Methods: We conducted a prospective randomized controlled trial comparing iMRI-guidance with conventional microsurgery in patients with contrast enhancing gliomas amenable to radiologically complete resection. Primary endpoint of this study was the rate of complete resections as determined by early postoperative MRI. In the iMRI group, a mobile ultra-low field iMRI device with a field strength of 0.15 T was used. All patients underwent high-field MRI within 7 days prior to and 72 hours following surgery. An independent radiologist who was blinded to the surgical treatment modality analyzed pre- and postoperative MRI data performing volumetric analyses. This study was approved by local authorities and was conducted in adherence to the Declaration of Helsinki and GCP-guidelines.

Results: 58 patients entered the study. Histological examination revealed metastasis in 8 patients, and 1 patient withdrew consent after randomization. Thus, 49 glioma patients could be analyzed. Patient characteristics (age, KPS score, preoperative tumor volume) were balanced between both groups. In the iMRI-group, intraoperative depiction of residual tumor led to additional resection in 8 patients (33.3%). Resections were complete in 23 out of 24 patients (95.8%) in the iMRI-group and in 17 out of 25 patients (68.0%) in the conventional group (P<0.05), which corresponded to significantly lower postoperative tumor volumes in the iMRI group (P<0.02). Overall morbidity was low and did not differ between groups (P=1.0).

Conclusions: We present scientific evidence that using iMRI-guidance in glioma surgery helps to achieve a higher rate of complete tumor resection compared to conventional microsurgery.