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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Beneficial impact of high-field intraoperative MRI on effectivity of pediatric low-grade glioma surgery

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  • Constantin Roder - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Germany
  • Martin Breitkopf - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Germany
  • Sotirios Bisdas - Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Tübingen, Germany
  • Artemisia Dimostheni - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Germany; Klinik für Neurochirurgie, Sektion pädiatrische Neurochirurgie, Universitätsklinikum Tübingen, Germany
  • Marcos Tatagiba - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Germany
  • Martin U. Schuhmann - Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Germany; Klinik für Neurochirurgie, Sektion pädiatrische Neurochirurgie, Universitätsklinikum Tübingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.15.08

doi: 10.3205/16dgnc187, urn:nbn:de:0183-16dgnc1876

Published: June 8, 2016

© 2016 Roder et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Intraoperative MRI (iMRI) is assumed to safely improve the extent of resection (EOR) in patients with gliomas. This study focusses on advantages of this technology in elective pediatric low-grade glioma (LGG) surgery compared to conventional surgery.

Method: Surgical results of pediatric patients with conventional and 1.5 Tesla iMRI-guided elective LGG surgery were reviewed retrospectively. Tumor volumes, general clinical data, as well the EOR including reference radiology assessment, and PFS were analyzed.

Results: 65 patients were included, 34 had conventional surgery before the iMRI-unit opened (pre-iMRI period), 31 were operated with iMRI-guidance (iMRI period). An intended complete resection (CR) was achieved according to the 3 months postoperative MRI (3/12 MRI) in 41% in the pre-iMRI and in 77% in the iMRI period (p=0.05). Of those patients with a postoperatively assumed CR, this proved to be true in only 50% in the pre-iMRI but in 81% in the iMRI period (p=0.055). Residual tumor volumes in the 3/12 MRI were significantly smaller in the iMRI cohort (p<0.03). By continuing the resection of residual tumor after the intraoperative scan (when the surgeon assumed a complete resection), the rate of complete resections increased from 30% at the time of the scan to 85% in the 3/12 MRI. Mean follow-up of patients was 36.9 (3-79) months. PFS of patients after iMRI-guided surgery was noticeably better for the entire iMRI cohort, and in patients with postoperatively assumed CRs, but did not quite reach statistical significance. PFS was highly significantly better in patients with CRs compared to incomplete resections (p<0.001).

Conclusions: Significantly better surgical results (CRs) and PFS were achieved in patients with intended total resections by using iMRI. Therefore, the use of high-field iMRI is strongly recommended for electively planned LGG resections in pediatric patients.