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Acta Neurochirurgica

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Open Access 16-11-2023 | Glioma | Original Article

The impact of intraoperative MRI on cranial surgical site infections—a single-center analysis

Authors: Ann-Kathrin Joerger, Xhimi Laho, Victoria Kehl, Bernhard Meyer, Sandro M. Krieg, Sebastian Ille

Published in: Acta Neurochirurgica | Issue 12/2023

Abstract

Purpose

The use of intraoperative MRI (ioMRI) contributes to an improved extent of resection. Hybrid operating room MRI suites have been established, with the patient being transferred to the MRI scanner. In the present descriptive analysis, we compared the rate of surgical site infections (SSI) after intracranial tumor surgery with and without the use of ioMRI.

Methods

In this retrospective study, we included 446 patients with open craniotomy performed for brain tumor surgery. One hundred fourteen patients were operated on with the use of ioMRI between June 1, 2018, and June 30, 2019 (group 1). During the same period, 126 patients were operated on without ioMRI (group 2). As an additional control group, we analyzed 206 patients operated on from February 1, 2017, to February 28, 2018 when ioMRI had not yet been implemented (group 3).

Results

The rate of SSI in group 1 (11.4%), group 2 (9.5%), and group 3 (6.8%) did not differ significantly (p = 0.352). Additional resection after ioMRI did not result in a significantly elevated number of SSI. No significant influence of re-resection, prior radio-/chemotherapy, blood loss or duration of surgery was found on the incidence of SSI.

Conclusion

Despite the transfer to a non-sterile MRI scanner, leading to a prolonged operation time, SSI rates with and without the use of ioMRI did not differ significantly. Hence, advantages of ioMRI outweigh potential disadvantages as confirmed by this real-life single-center study.

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Abu Hamdeh S, Lytsy B, Ronne-Engstrom E (2014) Surgical site infections in standard neurosurgery procedures- a study of incidence, impact and potential risk factors. Br J Neurosurg 28:270–275. https://doi.org/10.3109/02688697.2013.835376CrossRefPubMed

Baden LR, Swaminathan S, Angarone M, Blouin G, Camins BC, Casper C, Cooper B, Dubberke ER, Engemann AM, Freifeld AG, Greene JN, Ito JI, Kaul DR, Lustberg ME, Montoya JG, Rolston K, Satyanarayana G, Segal B, Seo SK et al (2016) Prevention and Treatment of Cancer-Related Infections, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 14:882–913. https://doi.org/10.6004/jnccn.2016.0093CrossRefPubMed

Barone DG, Lawrie TA, Hart MG (2014) Image guided surgery for the resection of brain tumours. Cochrane Database Syst Rev CD009685. https://doi.org/10.1002/14651858.CD009685.pub2

Bhave VM, Lamba N, Aizer AA, Bi WL (2023) Minimizing Intracranial Disease Before Stereotactic Radiation in Single or Solitary Brain Metastases. Neurosurgery. https://doi.org/10.1227/neu.0000000000002491

Bohinski RJ, Kokkino AK, Warnick RE, Gaskill-Shipley MF, Kormos DW, Lukin RR, Tew JM, Jr. (2001) Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection. Neurosurgery 48:731-742; discussion 742-734. https://doi.org/10.1097/00006123-200104000-00007

Cheng H, Chen BP, Soleas IM, Ferko NC, Cameron CG, Hinoul P (2017) Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt) 18:722–735. https://doi.org/10.1089/sur.2017.089CrossRefPubMed

Chiang HY, Kamath AS, Pottinger JM, Greenlee JD, Howard MA 3rd, Cavanaugh JE, Herwaldt LA (2014) Risk factors and outcomes associated with surgical site infections after craniotomy or craniectomy. J Neurosurg 120:509–521. https://doi.org/10.3171/2013.9.JNS13843CrossRefPubMed

Dinevski N, Sarnthein J, Vasella F, Fierstra J, Pangalu A, Holzmann D, Regli L, Bozinov O (2017) Postoperative Neurosurgical Infection Rates After Shared-Resource Intraoperative Magnetic Resonance Imaging: A Single-Center Experience with 195 Cases. World Neurosurg 103:275–282. https://doi.org/10.1016/j.wneu.2017.03.093CrossRefPubMed

Divo MJ, Martinez CH, Mannino DM (2014) Ageing and the epidemiology of multimorbidity. Eur Respir J 44:1055–1068. https://doi.org/10.1183/09031936.00059814CrossRefPubMedPubMedCentral

10.

Feigl GC, Heckl S, Kullmann M, Filip Z, Decker K, Klein J, Ernemann U, Tatagiba M, Velnar T, Ritz R (2019) Review of first clinical experiences with a 1.5 Tesla ceiling-mounted moveable intraoperative MRI system in Europe. Bosn J Basic Med Sci 19:24–30. https://doi.org/10.17305/bjbms.2018.3777CrossRefPubMedPubMedCentral

11.

Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 59:255–263. https://doi.org/10.1093/gerona/59.3.m255CrossRefPubMed

12.

Jankovski A, Francotte F, Vaz G, Fomekong E, Duprez T, Van Boven M, Docquier MA, Hermoye L, Cosnard G, Raftopoulos C (2008) Intraoperative magnetic resonance imaging at 3-T using a dual independent operating room-magnetic resonance imaging suite: development, feasibility, safety, and preliminary experience. Neurosurgery 63:412-424; discussion 424-416. https://doi.org/10.1227/01.NEU.0000324897.59311.1C

13.

Kuhnt D, Becker A, Ganslandt O, Bauer M, Buchfelder M, Nimsky C (2011) Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field intraoperative MRI guidance. Neuro Oncol 13:1339–1348. https://doi.org/10.1093/neuonc/nor133CrossRefPubMedPubMedCentral

14.

Kumar N, Madhu S, Bohra H, Pandita N, Wang SSY, Lopez KG, Tan JH, Vellayappan BA (2020) Is there an optimal timing between radiotherapy and surgery to reduce wound complications in metastatic spine disease? A systematic review. Eur Spine J 29:3080–3115. https://doi.org/10.1007/s00586-020-06478-5CrossRefPubMed

15.

Leroy HA, Delmaire C, Le Rhun E, Drumez E, Lejeune JP, Reyns N (2019) High-field intraoperative MRI and glioma surgery: results after the first 100 consecutive patients. Acta Neurochir (Wien) 161:1467–1474. https://doi.org/10.1007/s00701-019-03920-6CrossRefPubMed

16.

McCutcheon BA, Ubl DS, Babu M, Maloney P, Murphy M, Kerezoudis P, Bydon M, Habermann EB, Parney I (2016) Predictors of Surgical Site Infection Following Craniotomy for Intracranial Neoplasms: An Analysis of Prospectively Collected Data in the American College of Surgeons National Surgical Quality Improvement Program Database. World Neurosurg 88:350–358. https://doi.org/10.1016/j.wneu.2015.12.068CrossRefPubMed

17.

O'Keeffe AB, Lawrence T, Bojanic S (2012) Oxford craniotomy infections database: a cost analysis of craniotomy infection. Br J Neurosurg 26:265–269. https://doi.org/10.3109/02688697.2011.626878CrossRefPubMed

18.

Pamir MN (2011) 3 T ioMRI: the Istanbul experience. Acta Neurochir Suppl 109:131–137. https://doi.org/10.1007/978-3-211-99651-5_20CrossRefPubMed

19.

Patel S, Thompson D, Innocent S, Narbad V, Selway R, Barkas K (2019) Risk factors for surgical site infections in neurosurgery. Ann R Coll Surg Engl 101:220–225. https://doi.org/10.1308/rcsann.2019.0001CrossRefPubMedPubMedCentral

20.

Schipmann S, Akalin E, Doods J, Ewelt C, Stummer W, Suero Molina E (2016) When the Infection Hits the Wound: Matched Case-Control Study in a Neurosurgical Patient Collective Including Systematic Literature Review and Risk Factors Analysis. World Neurosurg 95:178–189. https://doi.org/10.1016/j.wneu.2016.07.093CrossRefPubMed

21.

Schweizer ML, Cullen JJ, Perencevich EN, Vaughan Sarrazin MS (2014) Costs Associated With Surgical Site Infections in Veterans Affairs Hospitals. JAMA Surg 149:575–581. https://doi.org/10.1001/jamasurg.2013.4663CrossRefPubMedPubMedCentral

22.

Soffietti R, Baumert BG, Bello L, Von Deimling A, Duffau H, Frenay M, Grisold W, Grant R, Graus F, Hoang-Xuan K, Klein M, Melin B, Rees J, Siegal T, Smits A, Stupp R, Wick W (2010) Guidelines on management of low-grade gliomas: report of an EFNS-EANO Task Force. Eur J Neurol 17:1124–1133. https://doi.org/10.1111/j.1468-1331.2010.03151.xCrossRefPubMed

23.

Wach J, Goetz C, Shareghi K, Scholz T, Hesselmann V, Mager AK, Gottschalk J, Vatter H, Kremer P (2019) Dual-Use Intraoperative MRI in Glioblastoma Surgery: Results of Resection, Histopathologic Assessment, and Surgical Site Infections. J Neurol Surg A Cent Eur Neurosurg 80:413–422. https://doi.org/10.1055/s-0039-1692975CrossRefPubMed

24.

Wen PY, Weller M, Lee EQ, Alexander BM, Barnholtz-Sloan JS, Barthel FP, Batchelor TT, Bindra RS, Chang SM, Chiocca EA, Cloughesy TF, DeGroot JF, Galanis E, Gilbert MR, Hegi ME, Horbinski C, Huang RY, Lassman AB, Le Rhun E et al (2020) Glioblastoma in adults: a Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions. Neuro Oncol 22:1073–1113. https://doi.org/10.1093/neuonc/noaa106CrossRefPubMedPubMedCentral

Title: The impact of intraoperative MRI on cranial surgical site infections—a single-center analysis
Authors: Ann-Kathrin Joerger
Xhimi Laho
Victoria Kehl
Bernhard Meyer
Sandro M. Krieg
Sebastian Ille
Publication date: 16-11-2023
Publisher: Springer Vienna
Keywords: Glioma
Glioma
Glioma
Published in: Acta Neurochirurgica / Issue 12/2023
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-023-05870-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The impact of intraoperative MRI on cranial surgical site infections—a single-center analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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