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

Progress of image guided surgery for GBM with iMRI surgery and synchronized 3D virtual navigation

Meeting Abstract

  • J. Yoshida - Department of Neurosurgery, Japan Labour Health and Welfare Organization Chubu Rousai Hospital; Department of Neurosurgery, Nagoya University, Graduate School of Medicine, Nagoya, Japan
  • T. Wakabayashi - Department of Neurosurgery, Nagoya University, Graduate School of Medicine, Nagoya, Japan
  • M. Fujii - Department of Neurosurgery, Nagoya University, Graduate School of Medicine, Nagoya, Japan
  • S. Maesawa - Department of Neurosurgery, Nagoya University, Graduate School of Medicine, Nagoya, Japan
  • Y. Kajita - Department of Neurosurgery, Nagoya University, Graduate School of Medicine, Nagoya, 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. DocDO.10.01

DOI: 10.3205/12dgnc091, URN: urn:nbn:de:0183-12dgnc0916

Published: June 4, 2012

© 2012 Yoshida et al.
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Outline

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Objective: Malignant glioma especially glioblastoma multiforme (GBM) is one of the most formidable neoplasm with poor prognosis of less than one year survival. In order to overcome this disease, we need new therapeutic strategies. And in this study, we evaluated the role and progress of our newly developed surgery.

Methods: In 2006, we installed two iMRI operative theaters; 1.5-T high-field "Brain SUITE" system in Nagoya Central Hospital and 0.4-T low-field "Brain THEATER" system in Nagoya University Hospital. Until Jan. 2011, 677 cases including 322 gliomas were treated by intraoperative MRI surgery. In motor eloquent area, surgery was navigated with pre- and intra-operative DTI based tractoqraphy of corticospinal tract and motor-evoked potential (MEP) monitoring and in speech eloquent area, it was navigated with tractography of language fibers such as arcuate fasciculus and awake surgery.

In deep seated glioma, surgery was navigated by synchronized 3D virtual microscopic images which was developed by advancement of imaqe rendering and fusion techniques combined with real microscope views.

Results: 58 cases of newly diagnosed GBM (group A) were treated with iMRI surgery and consecutive 24 cases of newly diagnosed GBM (group B) treated without iMRI. And we have confirmed the difference between two groups by evaluation of resection rate of tumor and post-operative survival time. In group A, over 95% of resection rate was 87% and less 95% was 13%. One year survival was 81%, two years 42% and median was 22.3 months. In contrast, in group B, over 95% was 42%, less 95% was 58%. One year survival rate was 75% and two years 17% and median 14.9 months.

Conclusions: 1. iMRI with integrated neuro-navigation provides functional information beyond standard anatomical imaging. 2. 3D virtual microscopic image data is useful to make pre-operative surgical planning and simulation, and intra-operative real time navigation. And in conjunction of iMRI, it provides a promising tool for total or near-total resection of GBM and increases useful survival time.