Artikel
Intraoperative MRI in brain tumor surgery: results of resection and histological assessment of glioblastoma surgery and safety of intraoperative MRI in dual use
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Autoren
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Johannes Wach
- Asklepios Klinik Nord, Department of Neurosurgery, Hamburg, Deutschland
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Claudia Goetz
- Asklepios Klinik Nord, Department of Neurosurgery, Hamburg, Deutschland
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Jörg Dornbusch
- Asklepios Klinik Nord, Department of Neurosurgery, Hamburg, Deutschland
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Joachim Gottschalk
- Asklepios Klinik Nord, Department of Pathology and Neuropathology, Hamburg, Deutschland
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Volker Hesselmann
- Asklepios Klinik Nord, Department of Radiology and Neuroradiology, Hamburg, Deutschland
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Ann-Kathrin Mager
- Asklepios Klinik Nord, Department of Radiology and Neuroradiology, Hamburg, Deutschland
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Paul Kremer
- Asklepios Klinik Nord, Department of Neurosurgery, Hamburg, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
Text
Objective: Extent of Resection (EoR) is a significant factor in the survival of glioblastoma (GBM) patients. Intraoperative MRI (IO-MRI) in dual use is a new concept to improve this. The aim of the study is to show the rate of Gross total resections (GTR), EoR and the histological results after IO-MRI in patients suffering from GBM. Furthermore, we evaluated the rate of surgical site infections (SSI) in a series of 197 patients.
Methods: We analysed 79 surgical procedures for GBM applying intraoperative 1.5 T MRI. IO-MRI was performed in all cases and residual Gd-enhancing tissue was resected in 55 cases. Histological assessment concerning the presence of tumor tissue of the resections after IO-MRI was evaluated. GTR and EoR were evaluated by segmentation and volumetric analysis of the MR-images. Furthermore, we evaluated the rate of surgical site infections (SSI) in 197 patients. Surgical site infections were defined as superficial infections, meningitis, subdural empyema, brain abscess and cerebritis. SSI and the use of perioperative antibiotics was analysed in 195 patients using Pearson´s chi-squared test. 118 of 195 patients received parenteral antibiotics and 77 of them additionally received intrathecal antibiotic injections composed of Vancomycin and Gentamicin. To ensure the sterility of this procedure, we used a covering consisting of various layers.
Results: GTR was achieved in 59 (74,68%) of the patients suffering from GBM. Mean EoR of all resections was 96,27%. In 45 (81,81%) of the 55 patients who underwent resections after IO-MRI tumor of astrocytic origin was confirmed by histopathological examinations. Overall SSI rate of the 197 patients operated in IO-MR suite was 4,06% (n=8). Rate of meningitis was 1,52 % (n=3) and the rate of brain abscess was 0,51 % (n=1). SSI of the group which received parenteral antibiotics was 5,1 %. Beyond, the other group with additional intrathecal antibiotic injections showed a SSI rate of 2,6%. Pearson´s two-tailed chi-squared test showed no significance concerning the two types of perioperative antibiotics and SSI. (p=0,392)
Conclusion: We found an obvious increase of GTR and EoR by using IO-MRI guided GBM resection compared to the rates before IO-MRI or other concepts without the use of IO-MRI. The rate of infections is low and within the normal range of neurosurgical procedures. Consequently, sharing a high-field MRI for daily diagnostic use and intraoperative resection control is a safe and successful concept.
