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

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The value of the intraoperative MRI in resection of skull base chordoma

Meeting Abstract

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  • Hussam Metwali - INI Hannover, Hannover, Deutschland
  • Venelin Gerganov - International Neuroscience Institute, Hannover, Deutschland
  • Helmut Bertalanffy - INI Hannover, Zentrum für Vaskuläre Neurochirurgie, Hannover, Deutschland
  • Rudolf Fahlbusch - International Neuroscience Institute Hannover, International Neuroscience Institute Hannover, Hannover, Deutschland
  • Madjid Samii - INI Hannover, Hannover, Deutschland
  • Amir Samii - INI International Neuroscience Institute, Hannover, 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. DocP 092

doi: 10.3205/17dgnc655, urn:nbn:de:0183-17dgnc6553

Published: June 9, 2017

© 2017 Metwali 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: Safe gross total resection of chordomas offers the best chances for overall survival and progression free survival. We are evaluating the value of the iMRI in achieving maximal safe resection of skull base chordomas.

Methods: Retrospective analysis of patients with skull base chordoma, who were operated at INI Hannover between 2010 and 2014, under navigation guidance and iMRI control (1.5 Tesla, Espree, Siemens). The preoperative images, the operative data and findings, the intraoperative MRI images and the surgeon’s expectations before performing the control were evaluated. The postoperative course and complications has been reported.

Results: Eight patients with skull base chordoma were operated under iMRI control. Two patients (25%) had recurrent tumors. Two patients (25%), operated first without iMRI, underwent redo surgery under iMRI. All the patients harbored tumor that extended into 2 or more skull base compartments. Five patients (62%) had intradural part of the tumor. The aim of surgery was gross total tumor resection in 4 patients (50%). In four patients (50%), the aim of surgery was tumor debulking and brainstem decompression. Six patients (75%) were operated via the endoscopically assisted extended transsphenoidal approach and one patient (12.5%) was operated via the anterior petrosal approach. The pterional approach was used in one patient (12.5%). Gross total resection was achieved, as planned, in 4 cases (50%). Tumor debulking and decompression of the brainstem were performed in 4 cases (50%). Repeated intraoperative control was necessary in three patients (37.5%) in whom the iMRI showed inadequate resection and/or inadequate decompression of the brainstem.

Conclusion: The iMRI is useful during resection of complex skull base chordoma which involve multiple skull base compartments. It can confirm the gross total resection of the tumor and give also an idea about the degree of debulking and brainstem decompression. According to the iMRI control, the surgeon may proceed for further resection.