gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Article

Send article

Intraoperative MR imaging of cerebral oxygen metabolism during resection of brain lesions

Meeting Abstract

Search Medline for

  • Karl Rössler - Department of Neurosurgery Erlangen, Erlangen, Deutschland
  • Andreas Merkel - Department of Neurosurgery Erlangen, Erlangen, Deutschland
  • Max Zimmermann - Department of Neurosurgery Erlangen, Erlangen, Deutschland
  • Björn Sommer - University Hospital Erlangen, Department of Neurosurgery, Erlangen, Deutschland
  • Michael Buchfelder - Universitätsklinikum Erlangen, Klinik für Neurochirurgie, Erlangen, Deutschland
  • Andreas Stadlbauer - Department of Neurosurgery Erlangen, Erlangen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.05.07

doi: 10.3205/17dgnc393, urn:nbn:de:0183-17dgnc3931

Published: June 9, 2017

© 2017 Rössler 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: Tissue oxygen tension is an important parameter for brain tissue viability and its non-invasive intraoperative monitoring in the whole brain is of highly clinical relevance. The purpose of this study was the introduction of a multiparametric quantitative blood oxygenation dependent (qBOLD) MRI approach for intraoperative examination of oxygen metabolism during the resection of brain lesions.

Methods: Sixteen patients suffering from various brain lesions (10 glioblastomas, 3 low-grade gliomas, 1 meningioma, 1 cavernoma and 1 AVM) were intraoperatively examined twice (before craniotomy and after gross-total resection) using the qBOLD technique and a 1.5 Tesla MR scanner, which is installed in an operating room. The MR protocol included T2*- and T2-mapping, and dynamic susceptibility-weighted (DSC) perfusion. Data analysis was performed using a custom-made in-house MatLab software for calculation of maps of oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) as well as of cerebral blood volume (CBV) and flow (CBF).

Results: Perilesional edema showed a significant increase in both perfusion (CBV +21%, CBF +13%) and oxygen metabolism (OEF +32%, CMRO2 +16%) after resection of the lesions. However, in perilesional non-edematous tissue only oxygen metabolism (OEF +19%, CMRO2 +11%) was significantly increased, but not perfusion. No changes were found in normal brain. Fortunately, no neurovascular adverse events were observed.

Conclusion: This approach for intraoperative examination of oxygen metabolism in the whole brain is a new application of intraoperative MRI additionally to resection control (residual tumor detection) and updating of neuronavigation (brain shift detection). Namely, it may help to detect neurovascular adverse events early during surgery.