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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Subcortical motor ischemia can be detected by intraoperative MRI within one hour – a case-control study

Subkortikale Ischämien mit Relevanz für die Motorik sind im intraoperativen MRT innerhalb 1 Stunde nachweisbar – eine Fall-Kontroll-Studie

Meeting Abstract

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  • presenting/speaker Sebastian Ille - Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Deutschland
  • Simon Schoen - Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Deutschland
  • Benedikt Wiestler - Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Deutschland
  • Bernhard Meyer - Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Deutschland
  • Sandro Krieg - Department of Neurosurgery, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP200

doi: 10.3205/21dgnc481, urn:nbn:de:0183-21dgnc4812

Veröffentlicht: 4. Juni 2021

© 2021 Ille 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: To achieve a maximum extent of resection, intraoperative MRI (ioMRI) scan is frequently performed. The present study evaluates the detection and clinical relevance of ischemia by ioMRI in patients with loss of motor evoked potentials (MEP) during glioma resection. Beyond its importance for neuro-oncology, such timewise highly accurate data is especially crucial for investigating early diagnostics of ischemic stroke.

Methods: Of 262 glioma patients between 07/2018 and 01/2020, eight patients (3.1%) showed an amplitude loss of continuous MEP monitoring during resection before the ioMRI scan (group loss of MEP=LOM). In these patients and a matched-pair cohort (MPC) of glioma resections without MEP loss, we performed additional ioMRI sequences including turbo-spin-echo (TSE)- and echo-planar-imaging (EPI)-diffusion-weighted imaging (DWI) with according apparent diffusion coefficient (ADC) maps and perfusion-weighted imaging (PWI). The clinical outcome was measured preoperatively, 5 days and 3 months after surgery.

Results: The mean±standard time between loss of MEPs and ioMRI was 63.0±8.7 min (range: 40-84). Ischemia within the motor system could be detected by ioMRI in group LOM in 100% EPI-DWIs, 100% EPI-ADCs, 75% TSE-DWIs, 87.5% TSE-ADCs, and 66.7% PWIs. No sequence showed motor ischemia in the MPC group. All patients of group LOM and no patient of group MPC suffered from permanent motor deficit.

Conclusion: Subcortical ischemia can be detected by ioMRI after MEP loss during the resection of motor-eloquent gliomas andwas clinically relevant in all cases. These findings are not only important in glioma surgery but of special interest in early diagnostics of ischemic stroke.