gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Intraoperative MRI in low-grade glioma surgery: Results of a multi-center retrospective assessment of the German study-group for intraoperative MRI

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  • Jan Coburger - Neurochirurgische Klinik, Universität Ulm, Standort Günzburg
  • Andreas Merkel - Neurochirurgische Klinik, Universitätsklinikum Erlangen
  • Moritz Scherer - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • Felix Schwartz - Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • Florian Gessler - Neurochirurgische Klinik, Universitätsklinikum Frankfurt
  • Constantin Roder - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • Andrej Pala - Neurochirurgische Klinik, Universität Ulm, Standort Günzburg
  • Ralph König - Neurochirurgische Klinik, Universität Ulm, Standort Günzburg
  • Mario Giordano - Neurochirurgische Klinik, International Neuroscience Institute Hannover
  • Hartmut Vatter - Neurochirurgische Klinik, Universitätsklinikum Bonn
  • Sotirios Bisdas - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • Arya Nabavi - Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • Rudolf Fahlbusch - Neurochirurgische Klinik, International Neuroscience Institute Hannover
  • Oliver Ganslandt - Neurochirurgische Klinik, Universitätsklinikum Erlangen
  • Marcos Tatagiba - Neurochirurgische Klinik, Universitätsklinikum Tübingen
  • Christian Senft - Neurochirurgische Klinik, Universitätsklinikum Frankfurt
  • H. Maximilian Mehdorn - Neurochirurgische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • Andreas W. Unterberg - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • Karl Rössler - Neurochirurgische Klinik, Universitätsklinikum Erlangen
  • Christian R. Wirtz - Neurochirurgische Klinik, Universität Ulm, Standort Günzburg

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMI.04.03

doi: 10.3205/15dgnc269, urn:nbn:de:0183-15dgnc2692

Published: June 2, 2015

© 2015 Coburger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: To investigate patient’s neurological outcome and progression-free survival (PFS) after intraoperative MRI (iMRI)-guided surgery for low-grade gliomas (LGG) in a multi-center retrospective study initiated by the German Study-Group for Intraoperative MRI (GeSGIM). Further, to evaluate the influence of the extent of resection (EoR) and adjuvant treatment on PFS and to assess the impact of low- vs. high-field iMRI-guided resections.

Method: A retrospective assessment of all patients (age 18 - 75 years) who had undergone iMRI-guided surgery of WHO°II LGGs in 6 iMRI centers was performed. Eloquent location, intended EoR, first line adjuvant treatment, use of neurophysiological monitoring, awake surgery, intraoperative ultrasound and use of high- or low-field iMRI were analyzed, as well as PFS, overall-survival (OS), new permanent neurological deficits (nPND) and general complications. Binary regression models were calculated to assess influence on EoR. Multivariate cox regression models were calculated to evaluate influence on PFS.

Results: 269 patients of 6 neurosurgical centers operated between 2000 and 2014 matched the inclusion criteria. 5-yr-PFS was 92%. 5-yr-OS was 100%. In multivariate analysis gross total resection (GTR) significantly increased PFS (hazard-ratio 0.38 p<0.01) while a “failed” GTR did not differ significantly from an intended sub-total-resection (STR). A combined radiochemotherapy as adjuvant treatment after surgery was a negative prognostic factor (HR 2.87 p<0.01). In a binary regression model use of high-field iMRI (HR 0.45 p<0.01) was significantly positively and eloquent location (HR 1.82 p<0.02) was negatively associated with a GTR. Use of low-field vs. high-field iMRI did not affect PFS. The rate of complications was 8%. Rate of nPND was 11%. GTR or the use of low- or high-field iMRI were not associated with nPND.

Conclusions: In this retrospective multicenter series, GTR was an independent positive prognostic factor for PFS in LGG-surgery, suggesting a radical resection to be the treatment of first choice in resectable tumors. Interestingly, PFS after failed GTR did not differ from patients after intended STR. High-field iMRI significantly improved rate of GTR in LGG surgery. Use of high- or low-field iMRI did not affect PFS. Increased EoR was not associated with increased rates of nPND. Adjuvant combined radiochemotherapy in WHO°II lesions was associated with decreased PFS.