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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Extent of resection and surgical morbidity using ultra-low field intraoperative MRI in glioma therapy: a matched pair analysis

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  • M. Bruder - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • A. Szelényi - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • V. Seifert - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main
  • C. Senft - Klinik für Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.04.05

doi: 10.3205/11dgnc013, urn:nbn:de:0183-11dgnc0135

Published: April 28, 2011

© 2011 Bruder et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The extent of resection in glioma surgery is a prognostic factor. To avoid sensory-motor deficits, neurophysiological monitoring (IOM) is commonly performed. We used a location – matched pair analysis of patients undergoing resections of eloquently located tumors with or without intraoperative MRI (iMRI)-guidance to evaluate beneficial or harmful effects of iMRI.

Methods: Data of 54 consecutive glioma patients undergoing tumor resection with an ultra-low field iMRI (PoleStar, 0.15T) using IOM between January 2007 and December 2009 were prospectively entered into a database. In the same period, 194 glioma patients underwent conventional microsurgical resection with IOM. We then performed a matched pair-analysis comparing the extent of resection and morbidity associated with the surgical procedure. Patients were matched for tumor location, tumor size, and contrast behaviour on high field MRI scans.

Results: 18 pairs of patients could be analyzed. There were 16 patients with contrast enhancing and 2 with non-enhancing tumors in each group. According to early postoperative high-field MRI (<48h), a complete resection was achieved in 15 patients (83.3%) in the iMRI group vs.10 patients (55.6%) in the control group (P=0.07). Using iMRI had led to continued resection in 8 patients (44.4%). 3 patients (16.7%) in the iMRI group and 2 patients (11.1%) in the control group showed a new neurological deficit (P=1.0). 6 patients in the iMRI group (33.3%) and 1 patient (5.6%) in the control group showed a transient aggravation of a pre-existing deficit (P<0.05), which all improved within a few days following surgery. There were no permanent disabling deficits in either group (P=1.0).

Conclusions: Using iMRI-guidance in combination with IOM techniques tends to enable higher rates of complete tumor resection in gliomas than conventional microsurgery. Although using iMRI might lead to a transient aggravation of pre-existing sensory-motor deficits, there is no higher risk for new permanent deficits or morbidity compared to conventional microsurgery.