742 Cost-effectiveness of Intraoperative Magnetic Resonance Imaging for Tumor Resection

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 518-519
Author(s):  
Walter A. Hall ◽  
Karen Kowalik ◽  
John Kucharczyk ◽  
Charles L. Truwit
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cost Effectiveness ◽  
Magnetic Resonance ◽  
Tumor Resection ◽  
Resonance Imaging ◽  
Intraoperative Magnetic Resonance Imaging

Impact of Intraoperative Magnetic Resonance Imaging and Other Factors on Surgical Outcomes for Newly Diagnosed Grade II Astrocytomas and Oligodendrogliomas: A Multicenter Study

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 63-73 ◽  
Author(s):  
Alexander T Yahanda ◽  
Bhuvic Patel ◽  
Amar S Shah ◽  
Daniel P Cahill ◽  
Garnette Sutherland ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Tumor Resection ◽  
Patient Treatment ◽  
Newly Diagnosed ◽  
Resonance Imaging ◽  
Total Resection ◽  
Intraoperative Magnetic Resonance Imaging ◽  
Grade Ii ◽  
The Impact

Abstract BACKGROUND Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative magnetic resonance imaging (iMRI) in the resection of grade II gliomas. OBJECTIVE To assess the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly diagnosed grade II astrocytomas and oligodendrogliomas. METHODS Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS and PFS. RESULTS A total of 232 resections (112 astrocytomas and 120 oligodendrogliomas) were analyzed. Oligodendrogliomas had longer OS (P < .001) and PFS (P = .01) than astrocytomas. Multivariate analyses demonstrated improved OS for gross total resection (GTR) vs subtotal resection (STR; P = .006, hazard ratio [HR]: .23) and near total resection (NTR; P = .02, HR: .64). GTR vs STR (P = .02, HR: .54), GTR vs NTR (P = .04, HR: .49), and iMRI use (P = .02, HR: .54) were associated with longer PFS. Frontal (P = .048, HR: 2.11) and occipital/parietal (P = .003, HR: 3.59) locations were associated with shorter PFS (vs temporal). Kaplan-Meier analyses showed longer OS with increasing extent of surgical resection (EOR) (P = .03) and 1p/19q gene deletions (P = .02). PFS improved with increasing EOR (P = .01), GTR vs NTR (P = .02), and resections above STR (P = .04). Factors influencing adjuvant treatment (35.3% of patients) included age (P = .002, odds ratio [OR]: 1.04) and EOR (P = .003, OR: .39) but not glioma subtype or location. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these instances. CONCLUSION EOR is a major determinant of OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.

scholarly journals Integration of Microanatomy, Neuronavigation, Dynamic Neurophysiologic Monitoring, and Intraoperative Multimodality Imaging for the Safe Removal of an Insular Glioma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Kyle Wu ◽  
Wenya Linda Bi ◽  
Walid Ibn Essayed ◽  
Viharkumar Patel ◽  
Paulo Kadri ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Multimodality Imaging ◽  
Video Recording ◽  
Tumor Resection ◽  
Internal Capsule ◽  
Resonance Imaging ◽  
Seamless Integration ◽  
Neurophysiologic Monitoring ◽  
Intraoperative Magnetic Resonance Imaging

Abstract Insular gliomas are located amongst myriad critical neurovascular structures, including lenticulostriate vessels, long insular perforators, putamen, internal capsule, frontal and temporal opercula, and key fasciculi.1-6 Each of these critical structures engenders key function of the brain, which must be preserved. Although anatomic knowledge remains the cornerstone of insular glioma surgery, novel tools have been developed to aid the surgeon in identifying and preserving these essential structures. Modern surgery of the insular glioma calls for seamless integration of these techniques to maximize the safety and totality of insular glioma resection, which has been shown to improve length of survival and seizure control, while reducing risk of tumor transformation.7-10 Neuronavigation can be used to help plan the craniotomy to achieve adequate exposure and assist during tumor resection. Brain “shift” can be corrected by re-registration following intraoperative magnetic resonance imaging (MRI). Interval ultrasound imaging reflects real-time progressive tumor resection. Dynamic neurophysiologic monitoring using thresholding techniques guides the surgeon as he resects tumor at its depth and posterior pole—close to the internal capsule. Intraoperative magnetic resonance imaging depicts residual infiltrative tumor that may require additional resection. The patient is a 33-yr-old woman with progressive growth of a right insular tumor and has consented to surgery, photography, and video recording.  Figure at 1:57, © Ossama Al-Mefty, used with permission.

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