Abstract
Aiming at providing high-class evidence regarding the use of intraoperative MRI (ioMRI), we are conducting a prospective randomized controlled trial. Adult patients with contrast enhancing lesions suspicious of malignant gliomas scheduled to undergo radiologically complete tumor resection are eligible to enter this trial. After giving their informed consent, patients are randomized to undergo either ioMRI-guided or conventional microneurosurgical tumor resection. To assess the extent of resection, pre- and early postoperative high-field MR images are obtained to perform volumetric analyses. Primary endpoint of the study is the rate of radiologically complete tumor resections. After the inclusion of 35 patients, we performed an interim analysis. In six patients, histopathological examination revealed metastases, so they were excluded from further analyses. Thus, data from 29 patients with gliomas could be analyzed. There were no significant differences in patient age (P=0.28) or preoperative tumor sizes (P=0.40) between the two treatment groups. We observed a trend towards a higher rate of complete tumor resections in the ioMRI-group compared to the control group (P=0.07). Postoperative tumor volumes were significantly lower in the ioMRI-group than in the control group (P<0.05). The use of ioMRI appears to be associated with a higher rate of radiographically complete as well as near total tumor resections compared to conventional microneurosurgery.
Keywords
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Black PM, Alexander E 3rd, Martin C, Moriarty T, Nabavi A, Wong TZ, Schwartz RB, Jolesz F (1999) Craniotomy for tumor treatment in an intraoperative magnetic resonance imaging unit. Neurosurgery 45:423–431, discussion 431–433
Hall WA, Liu H, Martin AJ, Pozza CH, Maxwell RE, Truwit CL (2000) Safety, efficacy, and functionality of high-field strength interventional magnetic resonance imaging for neurosurgery. Neurosurgery 46:632–641, discussion 641–642
Knauth M, Wirtz CR, Tronnier VM, Aras N, Kunze S, Sartor K (1999) Intraoperative MR imaging increases the extent of tumor resection in patients with high-grade gliomas. AJNR Am J Neuroradiol 20:1642–1646
Nimsky C, Fujita A, Ganslandt O, Von Keller B, Fahlbusch R (2004) Volumetric assessment of glioma removal by intraoperative high-field magnetic resonance imaging. Neurosurgery 55:358–370, discussion 370–371
Schulder M, Carmel PW (2003) Intraoperative magnetic resonance imaging: impact on brain tumor surgery. Cancer Control 10:115–124
Seifert V, Zimmermann M, Trantakis C, Vitzthum HE, Kuhnel K, Raabe A, Bootz F, Schneider JP, Schmidt F, Dietrich J (1999) Open MRI-guided neurosurgery. Acta Neurochir (Wien) 141:455–464
Senft C, Seifert V, Hermann E, Franz K, Gasser T (2008) Usefulness of intraoperative ultralow-field magnetic resonance imaging in glioma surgery. Neurosurgery 63:257–266, discussion 266–257
Schneider JP, Trantakis C, Rubach M, Schulz T, Dietrich J, Winkler D, Renner C, Schober R, Geiger K, Brosteanu O, Zimmer C, Kahn T (2005) Intraoperative MRI to guide the resection of primary supratentorial glioblastoma multiforme – a quantitative radiological analysis. Neuroradiology 47:489–500
Wirtz CR, Knauth M, Staubert A, Bonsanto MM, Sartor K, Kunze S, Tronnier VM (2000) Clinical evaluation and follow-up results for intraoperative magnetic resonance imaging in neurosurgery. Neurosurgery 46:1112–1120, discussion 1120–1122
Hirschberg H, Samset E, Hol PK, Tillung T, Lote K (2005) Impact of intraoperative MRI on the surgical results for high-grade gliomas. Minim Invasive Neurosurg 48:77–84
Hadani M, Spiegelman R, Feldman Z, Berkenstadt H, Ram Z (2001) Novel, compact, intraoperative magnetic resonance imaging-guided system for conventional neurosurgical operating rooms. Neurosurgery 48:799–807, discussion 807–809
Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7:392–401
Tuominen J, Yrjana SK, Katisko JP, Heikkila J, Koivukangas J (2003) Intraoperative imaging in a comprehensive neuronavigation environment for minimally invasive brain tumour surgery. Acta Neurochir Suppl 85:115–120
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 742–744
Oh DS, Black PM (2005) A low-field intraoperative MRI system for glioma surgery: is it worthwhile? Neurosurg Clin N Am 16:135–141
Schulder M (2009) Intracranial surgery with a compact, low-field-strength magnetic resonance imager. Top Magn Reson Imaging 19:179–189
Senft C, Franz K, Ulrich CT, Bink A, Szelenyi A, Gasser T, Seifert V (2010) Low field intraoperative MRI-guided surgery of gliomas: A single center experience. Clin Neurol Neurosurg 112:237–243
McGirt MJ, Chaichana KL, Gathinji M, Attenello FJ, Than K, Olivi A, Weingart JD, Brem H, Quinones-Hinojosa A (2009) Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 110:156–162
Sanai N, Berger MS (2008) Glioma extent of resection and its impact on patient outcome. Neurosurgery 62:753–764, discussion 264–756
Stummer W, Reulen HJ, Meinel T, Pichlmeier U, Schumacher W, Tonn JC, Rohde V, Oppel F, Turowski B, Woiciechowsky C, Franz K, Pietsch T (2008) Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery 62:564–576, discussion 564–576
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag/Wien
About this chapter
Cite this chapter
Senft, C., Bink, A., Heckelmann, M., Gasser, T., Seifert, V. (2011). Glioma Extent of Resection and Ultra-Low-Field iMRI: Interim Analysis of a Prospective Randomized Trial. In: Pamir, M., Seifert, V., Kiris, T. (eds) Intraoperative Imaging. Acta Neurochirurgica Supplementum, vol 109. Springer, Vienna. https://doi.org/10.1007/978-3-211-99651-5_8
Download citation
DOI: https://doi.org/10.1007/978-3-211-99651-5_8
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-99650-8
Online ISBN: 978-3-211-99651-5
eBook Packages: MedicineMedicine (R0)