gms | German Medical Science

Objective: Surgical treatment for patients with recurrent glioblastomas (GBMs) can be considered in about one-fourth of the patients, whereas major limitations are age, Karnofsky performance status (KPS) and tumor volume. Intraoperative MRI (iMRI)-guided surgery of newly diagnosed high-grade gliomas is known to improve the extent of resection (EOR) and the survival of patients, whereas iMRI surgery for recurrent GBMs has not been investigated to date.

Method: Retrospective analysis of patients with intended total resections of recurrent GBMs was performed comparing conventional versus iMRI-guided surgery. Main parameters included the extent of resection, perioperative clinical data and neurological outcome.

Results: 17 patients in the conventional and 12 in the iMRI-guided surgery group met the inclusion criteria. While preoperative tumor-volumes were comparable, postoperative MRI showed marked differences between the conventional and iMRI-guided surgery groups (Mean 1.878 (0–10.15) vs. 0.684 (0–3.80) cm³). Yet statistical significance could not be reached with a p-value of 0.19. Neurological outcome did not differ significantly between cohorts, but the postoperative ICU stay was significantly shorter (1.0 (1–1) vs. 1.75 (1–5) days; p=0.02) and hospital stay almost significantly (7.18 (4–17) vs. 9.1 (5–15) days; p=0.12) longer in the iMRI group compared to the conventional cohort.

Conclusions: Analysis of iMRI-guided surgery on recurrent GBMs revealed strong tendencies to be beneficial for the extent of resection compared to conventional surgery with comparable neurological outcomes. Nevertheless, careful patient selection is needed to prevent extended hospital stays and limitations of patient’s life quality due to neurological deficits after surgery of recurrent GBMs. Future randomized multicenter studies are needed to analyze whether iMRI-guided surgery of recurrent GBMs can improve survival with good life quality in carefully selected cohorts.