scholarly journals Low-grade Glioma Surgery in Intraoperative Magnetic Resonance Imaging

Neurosurgery ◽  
2015 ◽  
Vol 78 (6) ◽  
pp. 775-786 ◽  
Author(s):  
Jan Coburger ◽  
Andreas Merkel ◽  
Moritz Scherer ◽  
Felix Schwartz ◽  
Florian Gessler ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Field Strength ◽  
Odds Ratio ◽  
Progression Free Survival ◽  
Neurological Deficits ◽  
Low Grade ◽  
Resonance Imaging ◽  
Free Survival ◽  
Intraoperative Magnetic Resonance Imaging

Abstract BACKGROUND: The ideal treatment strategy for low-grade gliomas (LGGs) is a controversial topic. Additionally, only smaller single-center series dealing with the concept of intraoperative magnetic resonance imaging (iMRI) have been published. OBJECTIVE: To investigate determinants for patient outcome and progression-free-survival (PFS) after iMRI-guided surgery for LGGs in a multicenter retrospective study initiated by the German Study Group for Intraoperative Magnetic Resonance Imaging. METHODS: A retrospective consecutive assessment of patients treated for LGGs (World Health Organization grade II) with iMRI-guided resection at 6 neurosurgical centers was performed. Eloquent location, extent of resection, first-line adjuvant treatment, neurophysiological monitoring, awake brain surgery, intraoperative ultrasound, and field-strength of iMRI were analyzed, as well as progression-free survival (PFS), new permanent neurological deficits, and complications. Multivariate binary logistic and Cox regression models were calculated to evaluate determinants of PFS, gross total resection (GTR), and adjuvant treatment. RESULTS: A total of 288 patients met the inclusion criteria. On multivariate analysis, GTR significantly increased PFS (hazard ratio, 0.44; P < .01), whereas “failed” GTR did not differ significantly from intended subtotal-resection. Combined radiochemotherapy as adjuvant therapy was a negative prognostic factor (hazard ratio: 2.84, P < .01). Field strength of iMRI was not associated with PFS. In the binary logistic regression model, use of high-field iMRI (odds ratio: 0.51, P < .01) was positively and eloquent location (odds ratio: 1.99, P < .01) was negatively associated with GTR. GTR was not associated with increased rates of new permanent neurological deficits. CONCLUSION: GTR was an independent positive prognostic factor for PFS in LGG surgery. Patients with accidentally left tumor remnants showed a similar prognosis compared with patients harboring only partially resectable tumors. Use of high-field iMRI was significantly associated with GTR. However, the field strength of iMRI did not affect PFS.

scholarly journals Early intra-treatment diffusion weighted magnetic resonance imaging in patients with recurrent nasopharyngeal carcinoma treated with nivolumab

2020 ◽  
Vol 6 (3) ◽  
pp. 568
Author(s):  
Tiffany Y. So ◽  
Qi-Yong Ai ◽  
Brigette B.Y. Ma ◽  
Ann D. King
Keyword(s):  
Magnetic Resonance Imaging ◽  
Overall Survival ◽  
Magnetic Resonance ◽  
Nasopharyngeal Carcinoma ◽  
Progression Free Survival ◽  
Tumour Volume ◽  
Resonance Imaging ◽  
Free Survival ◽  
Diffusion Weighted ◽  
Weighted Magnetic Resonance Imaging

<p class="abstract">Immune check point inhibitors have demonstrated promising efficacy in patients with recurrent or metastatic nasopharyngeal carcinoma (NPC) in phase I and phase II trials. Early identification of treatment response is important in these patients. This report aimed to document the early intratreatment diffusion weighted magnetic resonance imaging (DW-MRI) findings in NPC patients following treatment with the programmed cell death-1 inhibitor, nivolumab. Two consecutive patients with histologically confirmed recurrent undifferentiated NPC treated with nivolumab were prospectively recruited. Nivolumab was administered at a dosage of 3 mg/kg intravenously every 2 weeks. Patients underwent magnetic resonance imaging examinations at baseline, and at 3 and 5 weeks after commencement of treatment. Intratreatment changes in tumour volume and apparent diffusion coefficient (ADC<sub>mean</sub>)were calculated. The endpoints were objective response by response evaluation criteria in solid tumors and survival. In patient 1, an intratreatment ADC increase at 5 weeks corresponded with anatomical tumour volume reduction and a better long-term survival outcome (progression free survival 1.3 years, overall survival 2.9 years). In patient 2, an intratreatment ADC decrease at 5 weeks corresponded to progressive disease and worse outcome (progression free survival 0.0 years, overall survival 0.9 years). Intratreatment ADC changes at 3 weeks were not associated with response outcome. These cases suggest that intratreatment changes in ADC at 5 weeks may potentially predict tumour response in patients treated with nivolumab. Dedicated studies are needed to clarify these findings and fully characterise patterns of treatment related ADC change.</p>

scholarly journals Initial Experience Using Intraoperative Magnetic Resonance Imaging During a Trans-Sulcal Tubular Retractor Approach for the Resection of Deep-Seated Brain Tumors: A Case Series

2018 ◽  
Vol 16 (3) ◽  
pp. 292-301 ◽  
Author(s):  
S Hassan A Akbari ◽  
Peter T Sylvester ◽  
Charles Kulwin ◽  
Mitesh V Shah ◽  
Aravind Somasundaram ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brain Tumors ◽  
Low Grade ◽  
Tumor Diameter ◽  
Resonance Imaging ◽  
Tubular Retractor ◽  
Average Hospital ◽  
Intraoperative Magnetic Resonance Imaging ◽  
Brain Retraction

Abstract BACKGROUND Treatment of deep-seated subcortical intrinsic brain tumors remains challenging and may be improved with trans-sulcal tubular brain retraction techniques coupled with intraoperative magnetic resonance imaging (iMRI). OBJECTIVE To conduct a preliminary assessment of feasibility and efficacy of iMRI in tubular retractor-guided resections of intrinsic brain tumors. METHODS Assessment of this technique and impact upon outcomes were assessed in a preliminary series of brain tumor patients from 2 centers. RESULTS Ten patients underwent resection with a tubular retractor system and iMRI. Mean age was 53.2 ± 9.0 yr (range: 37-61 yr, 80% male). Lesions included 6 gliomas (3 glioblastomas, 1 recurrent anaplastic astrocytoma, and 2 low-grade gliomas) and 4 brain metastases (1 renal cell, 1 breast, 1 lung, and 1 melanoma). Mean maximal tumor diameter was 2.9 ± 0.95 cm (range 1.2-4.3 cm). The iMRI demonstrated subtotal resection (STR) in 6 of 10 cases (60%); additional resection was performed in 5 of 6 cases (83%), reducing STR rate to 2 of 10 cases (20%), with both having tumor encroaching on eloquent structures. Seven patients (70%) were stable or improved neurologically immediately postoperatively. Three patients (30%) had new postoperative neurological deficits, 2 of which were transient. Average hospital length of stay was 3.4 ± 2.0 d (range: 1-7 d). CONCLUSION Combining iMRI with tubular brain retraction techniques is feasible and may improve the extent of resection of deep-seated intrinsic brain tumors that are incompletely visualized with the smaller surgical exposure of tubular retractors.

Intraoperative Magnetic Resonance Imaging-guided neurosurgery at 3-T

2006 ◽  
Vol 58 (suppl_4) ◽  
pp. ONS-338-ONS-346 ◽  
Author(s):  
Charles L. Truwit ◽  
Walter A. Hall
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Field ◽  
Magnetic Resonance ◽  
Field Strength ◽  
Intraoperative Imaging ◽  
Surgical Techniques ◽  
Main Magnetic Field ◽  
Neurosurgical Procedures ◽  
Resonance Imaging ◽  
Intraoperative Magnetic Resonance Imaging

Abstract Objective: Between 1997 and 2004, more than 700 neurosurgical procedures were performed in a 1.5-T magnetic resonance-guided therapy suite. During this period, the concept of high-field intraoperative magnetic resonance imaging (MRI) was validated, as was a new surgical guidance tool, the Navigus (Image-guided Neurologics, Melbourne, FL), and its methodology, prospective stereotaxy. Clinical protocols were refined to optimize surgical techniques. That implementation, the “Minnesota suite, ” has recently been revised, and a new suite with a 3-T MRI scanner has been developed. Methods: On the basis of experience at the initial 1.5-T suite, a new suite was designed to house a 3-T MRI scanner with wide surgical access at the rear of the scanner (opposite the patient couch). Use of electrocautery, a fiberoptic headlamp, a power drill, and MRI-compatible neurosurgical cutlery was anticipated by inclusion of waveguides and radiofrequency filter panels that penetrate the MRI suite's radiofrequency shield. An MRI-compatible head holder was adapted for use on the scanner table. A few items exhibiting limited ferromagnetism were used within the magnetic field, taking strict precautions. Results: During the initial procedures (all magnetic resonance-guided neurobiopsies), the new suite functioned as anticipated. Although metallic artifact related to titanium needles is more challenging at 3 T than at 1.5 T, it can be contained even at 3 T. Similar to 1.5 T, such artifact is best contained when the device is oriented along B0, the main magnetic field. Surgical needles, disposable scalpels, and disposable razors, despite being minimally ferromagnetic, were easily controlled by the surgeon. Conclusion: An intraoperative magnetic resonance-guided neurosurgical theater has been developed with a 3-T MRI scanner. Intraoperative imaging is feasible at this field strength, and concerns regarding specific absorption rate can be allayed. Infection control procedures can be designed to permit neurosurgery within this environment. Despite the increase in magnetic field strength, safety can be maintained.

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