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Acta Neurochirurgica

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01-07-2019 | Glioma | Original Article - Tumor - Glioma

High-field intraoperative MRI and glioma surgery: results after the first 100 consecutive patients

Authors: Henri-Arthur Leroy, Christine Delmaire, Emilie Le Rhun, Elodie Drumez, Jean-Paul Lejeune, Nicolas Reyns

Published in: Acta Neurochirurgica | Issue 7/2019

Abstract

Background

High-field intraoperative MRI (IoMRI) is part of the neurosurgical armamentarium to improve the extent of glioma resection (EOR).

Objective

To report our oncological and functional outcomes using IoMRI for neuronavigated glioma surgery.

Methods

In this prospective monocentric study, we reported 100 consecutive adult patients operated on for glioma using IoMRI with neuronavigation, under general anesthesia without intraoperative stimulation, from July 2014 to April 2017. The volumetric evaluation was based on the FLAIR hypersignal for non-enhancing tumors after Gadolinium infusion and on the T1 hypersignal after Gadolinium infusion for enhancing tumors. We evaluated the surgical workflow, the EOR and the clinical outcomes (using Karnofsky performance score (KPS)).

Results

Sixty-nine patients underwent one IoMRI, and 31 from two IoMRI controls. At first IoMRI, the median tumor residue was higher in the FLAIR group than in the T1G+ group whereas no more difference was reported after the second IoMRI between the 2 groups (p = 0.56). Additional resection was performed 6 times more frequently in the FLAIR group (OR = 5.7, CI (1.9–17)). The median EOR was 100% (IQR, 93.6–100) whatever the tumor type (first surgery or recurrence) and location. Higher residues were reported only in the insula area (p = 0.004). The median KPS was 90 (IQR, 80–100) at discharge, 3, 6 and 12 months after surgery, with no statistical difference between low- and high-grade gliomas (p = 0.34).

Conclusion

IoMRI neuronavigated surgery provided maximal EOR whatever the type of glioma and location. IoMRI was all the more useful for non- or minimally enhancing tumors. The step by step surgical resection, introducing the concept of “staged volume” surgery, ensured a high security for the surgeon and low permanent morbidity for the patients.

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Title: High-field intraoperative MRI and glioma surgery: results after the first 100 consecutive patients
Authors: Henri-Arthur Leroy
Christine Delmaire
Emilie Le Rhun
Elodie Drumez
Jean-Paul Lejeune
Nicolas Reyns
Publication date: 01-07-2019
Publisher: Springer Vienna
Keywords: Glioma
Glioma
Glioma
Published in: Acta Neurochirurgica / Issue 7/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-019-03920-6

At a glance: The STEP trials

Springer Medicine

High-field intraoperative MRI and glioma surgery: results after the first 100 consecutive patients

Abstract

Background

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

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