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

Integrated surgical procedure for gliomas: High-field intraoperative MRI in glioma surgery

Meeting Abstract

  • K. Sakurada - Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Japan
  • A. Kuge - Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Japan
  • S. Takemura - Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Japan
  • H. Huniu - Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Japan
  • Y. Kokubo - Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Japan
  • S. Sato - Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Japan
  • T. Kayama - Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Japan; National Cancer Center, 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.01.04

DOI: 10.3205/12dgnc002, URN: urn:nbn:de:0183-12dgnc0020

Published: June 4, 2012

© 2012 Sakurada 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: Extensive surgical removal of tumor tissue contributes to longer life expectancy for patients with brain tumors. As dynamic changes occur during surgical procedures, intraoperative magnetic resonance imaging (iMRI) is important for safe and maximal resection of brain tumors. In July 2008, a new operating room equipped with an intraoperative high-field MRI (1.5 T) system, neuronavigation, and fluorescence diagnostic system (Surgical Suite®) opened at the Yamagata University Hospital. We present our 3 years of experience using this suite, and discuss its advantages and limitations.

Methods: Preoperatively, 3-T MR studies including morphological studies, multivoxel MR spectroscopy, tractography and functional MRI were performed. If the tumor was located in or near the eloquent area, we monitored the motor evoked potentials (MEP) and sensory evoked potentials (SEP) and/or performed awake surgery using cortical and subcortical stimulation. Intraoperative MRI was performed after total resection or to update data regarding brain shift during removal of deep-seated tumors. To detect brain events, various MR sequences, including diffusion weighted imaging (DWI), were used.

Results: Using this new suite, we have safely treated over 200 cases including gliomas, metastatic brain tumors, menigniomas and pituitary adenomas. Combination of iMRI and MEP monitoring were performed in this new suite and we have safely treated over 200 cases, including gliomas, metastatic brain tumors, menigniomas and pituitary adenomas. The combination of iMRI and MEP monitoring were performed in 32 cases. MEP amplitude decreased in 4 patients and iDWI could detect intra-tumoral hemorrhage. However, the sensitivity and specificity of iDWI for ischemic events were low. The use of iMRI contributed to an improvement in the glioma resection rate in 34% of the cases, and gross total resection was achieved in 65% of the patients. Acute subdural hematoma in one patient was diagnosed by iMRI.

Conclusions: iMRI system with intraoperative monitoring and various preoperative imaging techniques provides valuable information for tumor resection that allows intraoperative modification of the surgical strategy. It could be very helpful in maximizing the resection and minimizing the morbidity.