Quantification of Glioma Removal by Intraoperative High-Field Magnetic Resonance Imaging: An Update

Abstract BACKGROUND: The beneficial role of the extent of resection (EOR) in glioma surgery in correlation to increased survival remains controversial. However, common literature favors maximum EOR with preservation of neurological function, which is shown to be associated with a significantly improved outcome. OBJECTIVE: In order to obtain a maximum EOR, it was examined whether high-field intraoperative magnetic resonance imaging (iMRI) combined with multimodal navigation contributes to a significantly improved EOR in glioma surgery. METHODS: Two hundred ninety-three glioma patients underwent craniotomy and tumor resection with the aid of intraoperative 1.5 T MRI and integrated multimodal navigation. In cases of remnant tumor, an update of navigation was performed with intraoperative images. Tumor volume was quantified pre- and intraoperatively by segmentation of T2 abnormality in low-grade and contrast enhancement in high-grade gliomas. RESULTS: In 25.9% of all cases examined, additional tumor mass was removed as a result of iMRI. This led to complete tumor resection in 20 cases, increasing the rate of gross-total removal from 31.7% to 38.6%. In 56 patients, additional but incomplete resection was performed because of the close location to eloquent brain areas. Volumetric analysis showed a significantly (P < .01) reduced mean percentage of tumor volume following additional further resection after iMRI from 33.5% ± 25.1% to 14.7% ± 23.3% (World Health Organization [WHO] grade I, 32.8% ± 21.9% to 6.1% ± 18.8%; WHO grade II, 24.4% ± 25.1% to 10.8% ± 11.0%; WHO grade III, 35.1% ± 27.3% to 24.8% ± 26.3%; WHO grade IV, 34.2% ± 23.7% to 1.2% ± 16.2%). CONCLUSION: MRI in conjunction with multimodal navigation and an intraoperative updating procedure enlarges tumor-volume reduction in glioma surgery significantly without higher postoperative morbidity.

Download Full-text

Volumetric Assessment of Glioma Removal by Intraoperative High-field Magnetic Resonance Imaging

Neurosurgery ◽

10.1227/01.neu.0000129694.64671.91 ◽

2004 ◽

Vol 55 (2) ◽

pp. 358-371 ◽

Cited By ~ 120

Author(s):

Christopher Nimsky ◽

Atsushi Fujita ◽

Oliver Ganslandt ◽

Boris von Keller ◽

Rudolf Fahlbusch

Keyword(s):

Magnetic Resonance ◽

High Field ◽

Tumor Volume ◽

Tumor Resection ◽

World Health ◽

Low Grade ◽

High Grade ◽

Resonance Imaging ◽

Glioma Surgery ◽

Health Organization

Abstract OBJECTIVE: To investigate the contribution of high-field intraoperative magnetic resonance imaging (iMRI) for further reduction of tumor volume in glioma surgery. METHODS: From April 2002 to June 2003, 182 neurosurgical procedures were performed with a 1.5-T magnetic resonance system. Among patients who underwent these procedures, 47 patients with gliomas (14 with World Health Organization Grade I or II glioma, and 33 with World Health Organization Grade III or IV glioma) who underwent craniotomy were investigated retrospectively. Completeness of tumor resection and volumetric analysis were assessed with intraoperative imaging data. RESULTS: Surgical procedures were influenced by iMRI in 36.2% of operations, and surgery was continued to remove residual tumor. Additional further resection significantly reduced the percentage of final tumor volume compared with first iMRI scan (6.9% ± 10.3% versus 21.4% ± 13.8%; P < 0.001). Percentages of final tumor volume also were significantly reduced in both low-grade (10.3% ± 11.5% versus 25.8% ± 16.3%; P < 0.05) and high-grade gliomas (5.4% ± 9.9% versus 19.5% ± 13.0%; P < 0.001). Complete resection was achieved finally in 36.2% of all patients (low-grade, 57.1%; high-grade, 27.3%). Among the 17 patients in whom complete tumor resection was achieved, 7 complete resections (41.2%) were attributable to further tumor removal after iMRI. We did not encounter unexpected events attributable to high-field iMRI, and standard neurosurgical equipment could be used safely. CONCLUSION: Despite extended resections, introduction of high-field iMRI in conjunction with functional navigation did not translate into an increased risk of postoperative deficits. The use of high-field iMRI increased radicality in glioma surgery without additional morbidity.

Download Full-text

Tumor Volume Assessment in Low-Grade Gliomas: A Comparison of Preoperative Magnetic Resonance Imaging to Coregistered Intraoperative 3-Dimensional Ultrasound Recordings

Neurosurgery ◽

10.1093/neuros/nyx392 ◽

2017 ◽

Vol 83 (2) ◽

pp. 288-296 ◽

Cited By ~ 3

Author(s):

Bodil Karoline Ravn Munkvold ◽

Hans Kristian Bø ◽

Asgeir Store Jakola ◽

Ingerid Reinertsen ◽

Erik Magnus Berntsen ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Tumor Volume ◽

Intraobserver Variability ◽

Low Grade ◽

Resonance Imaging ◽

Glioma Surgery ◽

Who Grade ◽

Low Grade Gliomas ◽

Tumor Delineation

Abstract BACKGROUND Image guidance based on magnetic resonance imaging (MRI) and/or ultrasound (US) is widely used to aid decision making in glioma surgery, but tumor delineation based on these 2 modalities does not always correspond. OBJECTIVE To analyze volumes of diffuse low-grade gliomas (LGGs) based on preoperative 3-D FLAIR MRIs compared to intraoperative 3-D US image recordings to quantitatively assess potential discrepancies between the 2 imaging modalities. METHODS Twenty-three patients with supratentorial WHO grade II gliomas undergoing primary surgery guided by neuronavigation based on preoperative FLAIR MRI and navigated 3-D US were included. Manual volume segmentation was performed twice in 3-D Slicer version 4.0.0 to assess intrarater variabilities and compare modalities with regard to tumor volume. Factors possibly related to correspondence between MRI and US were also explored. RESULTS In 20 out of 23 patients (87%), the LGG tumor volume segmented from intraoperative US data was smaller than the tumor volume segmented from the preoperative 3-D FLAIR MRI. The median difference between MRI and US volumes was 7.4 mL (range: −4.9-58.7 mL, P < .001) with US LGG volumes corresponding to a median of 74% (range: 42%-183%) of the MRI LGG volumes. However, there was considerable intraobserver variability for US volumes. The correspondence between MRI and US data was higher for astrocytomas (92%). CONCLUSION The tumor volumes of LGGs segmented from intraoperative US images were most often smaller than the tumor volumes segmented from preoperative MRIs. There was a much better match between the 2 modalities in astrocytomas.

Download Full-text

CTNI-20. PCV CHEMOTHERAPY ALONE IS ASSOCIATED WITH BETTER CLINICAL COURSE IN OLIGODENDROGLIOMA WHO GRADE II

Neuro-Oncology ◽

10.1093/neuonc/noaa215.187 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii46-ii46

Author(s):

Jonathan Weller ◽

Sophie Katzendobler ◽

Philipp Karschnia ◽

Stefanie Lietke ◽

Rupert Egensperger ◽

...

Keyword(s):

Stereotactic Biopsy ◽

Tumor Volume ◽

Treatment Guidelines ◽

Tumor Resection ◽

World Health ◽

Incomplete Resection ◽

Watch And Wait ◽

Who Grade ◽

Long Term Outcome ◽

Pcv Chemotherapy

Abstract BACKGROUND Current treatment guidelines for oligodendrogliomas (OD) recommend watch-and-wait strategies after gross total resection and radiation with subsequent chemotherapy (procarbazine, CCNU and vincristine (PCV)) after incomplete resection. The value of chemotherapy alone as an option to delay the risk of late cognitive deficits is not well defined yet. Here, we retrospectively investigated long-term outcome in OD WHO II with respect to initial therapy and tumor volume in magnetic resonance imaging (MRI). METHODS A total of 142 patients with OD WHO (World Health Organization) II according to WHO 2016 were retrospectively included. Patients either had watch and wait (W&W) after histological sampling through stereotactic biopsy (n=59) or tumor resection (n=27) or else stereotactic biopsy with subsequent temozolomide (TMZ) (n=26) or PCV (n=30). Pre- and post-therapeutic T2 tumor volumes were obtained. Progression-free survival (PFS), post-recurrence PFS (PR-PFS) and rate of secondary malignization after 10 years (MR-10yrs) were correlated with clinical and volumetric data. RESULTS PFS was significantly longer in the PCV cohort compared to TMZ (9.1 vs. 3.6 years, p = 0.04), even after matching patients according to age and initial tumor volume (9.1 vs 4.7 yrs, p = 0.03). PFS in the W&W cohort was 5.1 years and 4.4 years in those receiving tumor resection only. MR-10yrs was 4% in PCV cohort, 18% in the W&W cohort and 52% in the resection only cohort (p = 0.01). In the W&W cohort, patients treated with PCV at first relapse had a longer PR-PFS than those treated with TMZ (in years, 7.2 vs 4.0, p = 0.04). Multivariate analysis confirmed initial PCV therapy (p = 0.01) and initial T2 tumor volume (p = 0.02) to be prognostic. CONCLUSION In oligodendrogliomas WHO II PCV chemotherapy alone is superior in terms of PFS and rate of secondary malignization compared to TMZ chemotherapy alone or tumor resection only.

Download Full-text

791 Extent of Brain Tumor Resection Using High-field (1.5-T) versus Low-field (0.2-T) Intraoperative Magnetic Resonance Imaging

Neurosurgery ◽

10.1097/00006123-200408000-00127 ◽

2004 ◽

pp. 483-484

Author(s):

Marvin Bergsneider ◽

Nouzhan Sehati ◽

Pablo Villablanca ◽

David McArthur ◽

Linda M. Liau

Keyword(s):

Magnetic Resonance Imaging ◽

Brain Tumor ◽

Magnetic Resonance ◽

High Field ◽

Tumor Resection ◽

Resonance Imaging ◽

Intraoperative Magnetic Resonance Imaging ◽

Low Field ◽

Brain Tumor Resection

Download Full-text

Utilization of Intraoperative Motor Mapping in Glioma Surgery with High-Field Intraoperative Magnetic Resonance Imaging

Stereotactic and Functional Neurosurgery ◽

10.1159/000319837 ◽

2010 ◽

Vol 88 (6) ◽

pp. 345-352 ◽

Cited By ~ 15

Author(s):

Mustafa Aziz Hatiboglu ◽

Jeffrey S. Weinberg ◽

Dima Suki ◽

Sudhakar Tummala ◽

Ganesh Rao ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

High Field ◽

Resonance Imaging ◽

Glioma Surgery ◽

Motor Mapping ◽

Intraoperative Magnetic Resonance Imaging

Download Full-text

Usefulness of Intraoperative Ultra Low-field Magnetic Resonance Imaging in Glioma Surgery

Operative Neurosurgery ◽

10.1227/01.neu.0000313624.77452.3c ◽

2008 ◽

Vol 63 (suppl_4) ◽

pp. ONS257-ONS267 ◽

Cited By ~ 42

Author(s):

Christian Senft ◽

Volker Seifert ◽

Elvis Hermann ◽

Kea Franz ◽

Thomas Gasser

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Tumor Resection ◽

Extent Of Resection ◽

Resonance Imaging ◽

Complete Tumor Resection ◽

Glioma Surgery ◽

Low Field ◽

Low Field Mri ◽

Complete Tumor

Abstract Objective: The aim of this study was to demonstrate the usefulness of a mobile, intraoperative 0.15-T magnetic resonance imaging (MRI) scanner in glioma surgery. Methods: We analyzed our prospectively collected database of patients with glial tumors who underwent tumor resection with the use of an intraoperative ultra low-field MRI scanner (PoleStar N-20; Odin Medical Technologies, Yokneam, Israel/Medtronic, Louisville, CO). Sixty-three patients with World Health Organization Grade II to IV tumors were included in the study. All patients were subjected to postoperative 1.5-T imaging to confirm the extent of resection. Results: Intraoperative image quality was sufficient for navigation and resection control in both high-and low-grade tumors. Primarily enhancing tumors were best detected on T1-weighted imaging, whereas fluid-attenuated inversion recovery sequences proved best for nonenhancing tumors. Intraoperative resection control led to further tumor resection in 12 (28.6%) of 42 patients with contrast-enhancing tumors and in 10(47.6%) of 21 patients with noncontrast-enhancing tumors. In contrast-enhancing tumors, further resection led to an increased rate of complete tumor resection (71.2 versus 52.4%), and the surgical goal of gross total removal or subtotal resection was achieved in all cases (100.0%). In patients with noncontrast-enhancing tumors, the surgical goal was achieved in 19 (90.5%) of 21 cases, as intraoperative MRI findings were inconsistent with postoperative high-field imaging in 2 cases. Conclusion: The use of the PoleStar N-20 intraoperative ultra low-field MRI scanner helps to evaluate the extent of resection in glioma surgery. Further tumor resection after intraoperative scanning leads to an increased rate of complete tumor resection, especially in patients with contrast-enhancing tumors. However, in noncontrast-enhancing tumors, the intraoperative visualization of a complete resection seems less specific, when compared with postoperative 1.5-T MRI.

Download Full-text

Use of Movable High-Field-Strength Intraoperative Magnetic Resonance Imaging With Awake Craniotomies for Resection of Gliomas: Preliminary Experience

Neurosurgery ◽

10.1227/neu.0b013e31821d0e4c ◽

2011 ◽

Vol 69 (1) ◽

pp. 194-206 ◽

Cited By ~ 30

Author(s):

Eric C Leuthardt ◽

Chris C H Lim ◽

Manish N Shah ◽

John A Evans ◽

Keith M Rich ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Field Strength ◽

Operating Room ◽

High Field ◽

Tumor Resection ◽

Awake Craniotomy ◽

Resonance Imaging ◽

High Field Strength ◽

Language Areas

Abstract BACKGROUND: Awake craniotomy with electrocortical mapping and intraoperative magnetic resonance imaging (iMRI) are established techniques for maximizing tumor resection and preserving function, but there has been little experience combining these methodologies. OBJECTIVE: To report our experience of combining awake craniotomy and iMRI with a 1.5-T movable iMRI for resection of gliomas in close proximity to eloquent cortex. METHODS: Twelve patients (9 male and 3 female patients; age, 32-60 years; mean, 41 years) undergoing awake craniotomy and iMRI for glioma resections were identified from a prospective database. Assessments were made of how these 2 modalities were integrated and what impact this strategy had on safety, surgical decision making, workflow, operative time, extent of tumor resection, and outcome. RESULTS: Twelve craniotomies were safely performed in an operating room equipped with a movable 1.5-T iMRI. The extent of resection was limited because of proximity to eloquent areas in 5 cases: language areas in 3 patients and motor areas in 2 patients. Additional tumor was identified and resected after iMRI in 6 patients. Average operating room time was 7.9 hours (range, 5.9-9.7 hours). Compared with preoperative neurological function, immediate postoperative function was stable/improved in 7 and worse in 5; after 30 days, it was stable/improved in 11 and worse in 1. CONCLUSION: Awake craniotomy and iMRI with a movable high-field-strength device can be performed safely to maximize resection of tumors near eloquent language areas.

Download Full-text