gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Information-guided surgical management of gliomas using low-field-strength intraoperative MRI in intelligent operating theater

Meeting Abstract

  • Y. Muragaki - Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
  • H. Iseki - Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
  • T. Maruyama - Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
  • T. Suzuki - Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
  • K. Yoshimitsu - Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
  • M. Chernov - Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
  • S. Ikuta - Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
  • M. Tamura - Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
  • J. Okamoto - Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
  • C. Niki - Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
  • M. Hayashi - Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
  • Y. Okada - Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocMI.01.02

DOI: 10.3205/12dgnc001, URN: urn:nbn:de:0183-12dgnc0015

Published: June 4, 2012

© 2012 Muragaki 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: Contemporary technological developments revolutionized surgical management of intraaxial brain tumors. The intraoperative MRI (iMRI) and updated neuronavigation permitted neurosurgeons to perform tumor resection under precise guidance. Neurophysiological monitoring and brain mapping allows precise localization of the cerebral functions and preservation of the important function during removal of the tumor. Intraoperative histopathological diagnosis allows fast direct investigation for the identification of the neoplastic cells. Incorporation of these adjuncts provides the surgeon with the opportunity of performing aggressive glioma resection with minimal risk of neurological morbidity. The present report highlights our experience with information-guided surgical management of gliomas using low magnetic field strength iMRI in the intelligent operating theater with an emphasis on tumor resection rate and outcome.

Methods: From 2000 to 2011, 1000 surgeries for intracranial lesions were performed with the use of intraoperative MRI (iMRI) with magnetic field strength of 0.3 Tesla, updated neuronavigation, serial intraoperative histopathological investigations and neurophysiological monitoring (797 gliomas, 45 cavernous malformations, 34 pituitary tumors, and other tumors). There were 468 cases of newly-diagnosed gliomas as well as WHO grade-II, -III, and -IV gliomas in 181, 137, and 150 cases, respectively.

Results: Maximal possible tumor resection, defined as radiologically complete tumor removal or subtotal removal leaving the residual neoplasm within the vital functionally-important brain areas, was attained in 996 cases (99.6%). Four cases were reoperated because of insufficient mapping (3 cases) and machine trouble occurred in 1 case. It is important to emphasize that our low-field-strength iMRI showed high sensitivity for the detection of the residual glioma, which was confirmed by postoperative high-field-strength MRI investigations. In no one case of the present series was unexpected residual tumor disclosed. The median resection rate of newly-diagnosed gliomas constituted 83%, 88%, and 94%, for WHO grade II, III, and IV gliomas, respectively, and the actual five-year survival rate was 97%, 78%, and 19%, respectively.

Conclusions: Information-guided management of gliomas using low-field-strength iMRI provides a good opportunity for maximal possible tumor resection, and may result in survival advantage.