gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Intraoperative radicality control with intraoperative MRI in low-grade glioma surgery

Intraoperative Radikalitätskontrolle mit intraoperativer MRT bei der Operation niedergradiger Gliome

Meeting Abstract

  • corresponding author Christian Rainer Wirtz - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • V. M. Tronnier - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • M. M. Bonsanto - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • R. Metzner - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • M. Hartmann - Abteilung Klinische Neuroradiologie, Ruprecht-Karls-Universität, Heidelberg
  • P. Kremer - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • S. Kunze - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • A. Unterberg - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.01.06

The electronic version of this article is the complete one and can be found online at:

Published: April 23, 2004

© 2004 Wirtz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




In low-grade gliomas radical resection often fails due to ill defined tumour margins even if neuronavigation is applied, since brain shift decreases its accuracy in many cases. Our goal was to evaluate the potential of intraoperative MRI (iMRI) to detect residual tumour intraoperatively and improve radiologically radical resection in operations for low-grade glioma.


53 patients with low-grade gliomas (43 WHO II, 10 WHO I) were operated with neuronavigation and iMRI to control radicality of resection and update navigational data. If residual tumour was suspected, navigation was rereferenced with the intraoperative datasets and the area was inspected. It was up to the surgeon to decide upon further resection, obtaining a biopsy or doing nothing at all. Imaging results were compared to histological findings, where samples were obtained.


With intraoperative MRI definitive residual tumour was found in 21 cases (40%), in 13 cases (25%) findings were suspicious and 13 times (25%) free of residual tumour. In 5 operations (10%) intraoperative findings were inconclusive. In 32 cases (59%) resection was continued, and/or a biopsy was obtained under navigational control. In 9 operations (17%) the surgeon stated to have left residual tumour deliberately. Early postoperative MRI revealed residual tumour in 7 patients (13%), suspicious findings in 6 cases (12%), radical resection in 35 cases (67%) and 4 times (8%) findings were inconclusive. 39 histological samples were obtained and compared with the findings of intraoperative MRI. Very good or good correlation was found in 34 samples (87%) whereas only 5 times (13%) correlation was bad or missing.


With iMRI residual tumour was found in a high percentage of cases despite neuronavigation. The good correlation between images and histological findings demonstrates the feasibility of the concept. With iMRI to update neuronavigation the radicality of resection can be improved in low grade glioma surgery. However, the clinical significance of increased radicality remains to be shown for low grade gliomas.