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70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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Impact of intraoperative MRI-guided resection in pediatric brain tumour surgery – a meta-analysis

Einfluss der intraoperativen MRT-gestützten Resektion von pädiatrischen Gehirntumoren – Eine Metaanalyse

Meeting Abstract

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  • presenting/speaker Johannes Wach - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
  • Mohammed Banat - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
  • Valeri Borger - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
  • Ralf Clauberg - Universitätsklinikum Bonn, Radiologie, Bonn, Deutschland
  • Hartmut Vatter - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
  • Hannes Haberl - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland
  • Sevgi Sarikaya-Seiwert - Universitätsklinikum Bonn, Neurochirurgie, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV316

doi: 10.3205/19dgnc334, urn:nbn:de:0183-19dgnc3349

Veröffentlicht: 8. Mai 2019

© 2019 Wach et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: Intraoperative magnet resonance imaging (MRI) has emerged as a powerful adjunct for resection of brain tumors. However, its exact role has not been firmly established. The purpose of our meta-analysis was to determine the impact of intraoperative MRI on surgical management of childhood CNS tumors.

Methods: A pubmed research adhering to PRISMA guidelines was investigated. Only 11 original articles in the English language literature have been published about IMRI in pediatric neurosurgery so far. We did a meta-analysis and focused mainly on what kind of histopathological entities were operated, which concepts were used, the improvement of the extent of resection (EoR) and the rate of adverse events. Gross Total resection (GTR) of high grade gliomas is defined as resection without visual residual enhancing tumor. In low grade glioma it was defined as complete removal of the hyperintense lesions in T2 and FLAIR. Pearson’s chi-squared tests (2-sided) for the evaluation of the EoR were performed.

Results: All analyzed articles were retrospective. 437 patients at the age of 18 or younger underwent IMRI-guided surgery. The tumor location was mainly supratentorial (n=319). The most common tumor was low-grade glioma (n=239, 55%) followed by pilocytic astrocytoma (n=91, 21%), and high grade glioma (n=60, 14%). Maximum amount of 3 IMRI were performed with an average of 1.7 scanning sessions per patient. IMRI related safety issues couldn’t be found. Additional tumor was resected after scanning in 27.79% of patients. Among 152 patients with a preoperative goal of a GTR, in 81% this goal could be achieved. Compared to the reported rate of GTR (n=33, 47%) without IMRI guided resections, EoR is improved significantly in pediatric low grade glioma surgery assisted by IMRI (p<0.001).

Conclusion: Intraoperative MRI is a safe method and increases the feasibility of gross total resection. Its availability reduces the need of early reoperation and repeated sedation for postoperative scans in children with brain tumors.