scholarly journals Intraoperative Magnetic Resonance Imaging Assisted Endoscopic Endonasal Resection of Clival Chordomas

2022 ◽  
Vol 11 ◽  
Author(s):  
Beste Gulsuna ◽  
Burak Karaaslan ◽  
Memduh Kaymaz ◽  
Hakan Emmez ◽  
Emetullah Cindil ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Skull Base ◽  
Residual Tumor ◽  
Gross Total Resection ◽  
Resonance Imaging ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Intraoperative Magnetic Resonance Imaging ◽  
Skull Base Chordomas

BackgroundCranial base chordomas are typically indolent and usually appear as encapsulated tumors. They slowly grow by infiltrating the bone, along with the lines of least resistance. Due to its relationship with important neurovascular structures, skull base chordoma surgery is challenging.ObjectiveThe usefulness of intraoperative magnetic resonance imaging (IO-MRI) in achieving the goal of surgery, is evaluated in this study.MethodsBetween March 2018 and March 2020, 42 patients were operated on for resection of skull base chordomas in our institution. All of them were operated on under IO-MRI. Patients were analyzed retrospectively for identifying common residue locations, complications and early post-operative outcomes.ResultsIn 22 patients (52,4%) gross total resection was achieved according to the final IO-MRI. In 20 patients (47,6%) complete tumor removal was not possible because of extension to the petrous bone (8 patients), pontocerebellar angle (6 patients), prepontine cistern (4 patients), temporobasal (1 patient), cervical axis (1 patient). In 13 patients, the surgery was continued after the first IO-MRI control was performed, which showed a resectable residual tumor. 7 of these patients achieved total resection according to the second IO-MRI, in the other 6 patients all efforts were made to ensure maximal resection of the tumor as much as possible without morbidity. Repeated IO-MRI helped achieve gross total resection in 7 patients (53.8%).ConclusionsOur study proves that the use of IO-MRI is a safe method that provides the opportunity to show the degree of resection in skull base chordomas and to evaluate the volume and location of the residual tumor intraoperatively. Hence IO-MRI can improve the life expectancy of patients because it provides an opportunity for both gross total resection and maximal safe resection in cases where total resection is not possible.

IMPACT OF INTRAOPERATIVE HIGH-FIELD MAGNETIC RESONANCE IMAGING GUIDANCE ON GLIOMA SURGERY

Neurosurgery ◽  
2009 ◽  
Vol 64 (6) ◽  
pp. 1073-1081 ◽  
Author(s):  
Mustafa Aziz Hatiboglu ◽  
Jeffrey S. Weinberg ◽  
Dima Suki ◽  
Ganesh Rao ◽  
Sujit S. Prabhu ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Field ◽  
Residual Tumor ◽  
Gross Total Resection ◽  
Resonance Imaging ◽  
Tumor Removal ◽  
Total Resection ◽  
Glioma Resection ◽  
Additional Tumor

Abstract OBJECTIVE To determine the impact of intraoperative magnetic resonance imaging (iMRI) on the decision to proceed with additional glioma resection during surgery and to maximize extent of resection (EOR). METHODS Patients who underwent craniotomy for glioma resection with high-field iMRI guidance were prospectively evaluated between September 2006 and August 2007. Volumetric analysis and EOR were assessed with iMRI, using postcontrast T1-weighted images for tumors showing contrast enhancement and T2-weighted images for nonenhancing tumors. RESULTS Forty-six patients underwent resection using iMRI guidance, with iMRI being used to evaluate the EOR in 44 patients and for reregistration in 2 patients. Surgery was terminated after iMRI in 23 patients (52%) because gross total resection was achieved or because of residual tumor infiltration in an eloquent brain region. Twenty-one patients (47%) underwent additional resection of residual tumor after iMRI. For enhancing gliomas, the median EOR increased significantly from 84% (range, 59%–97%) to 99% (range, 85%–100%) with additional tumor removal after iMRI (P < 0.001). For nonenhancing gliomas, the median EOR increased (from 63% to 80%) with additional tumor removal after iMRI, but not significantly, owing to the small sample size (7 patients). Overall, the EOR increased from 76% (range, 35%–97%) to 96% (range, 48%–100%) (P < 0.001). Gross total resection was achieved after additional tumor removal after iMRI in 15 of 21 patients (71%). Overall, 29 patients (65%) experienced gross total resection, and in 15 (52%), this was achieved with the contribution of iMRI. CONCLUSION High-field iMRI is a safe and reliable technique, and its use optimizes the extent of glioma resection.

The Significance of Intraoperative Magnetic Resonance Imaging in Resection of Skull Base Chordomas

2019 ◽  
Vol 128 ◽  
pp. e185-e194
Author(s):  
Hussam Metwali ◽  
Amir Samii ◽  
Venelin Gerganov ◽  
Mario Giordano ◽  
Rudolf Fahlbusch ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Skull Base ◽  
Resonance Imaging ◽  
Intraoperative Magnetic Resonance Imaging ◽  
Skull Base Chordomas

Endoscopic Transsphenoidal Pituitary Surgery with Intraoperative Magnetic Resonance Imaging

2006 ◽  
Vol 58 (suppl_1) ◽  
pp. ONS-44-ONS-51 ◽  
Author(s):  
Theodore H. Schwartz ◽  
Phillip E. Stieg ◽  
Vijay K. Anand
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Liquid Crystal Display ◽  
Residual Tumor ◽  
Pituitary Surgery ◽  
Resonance Imaging ◽  
Endoscopic Endonasal ◽  
Intraoperative Magnetic Resonance Imaging ◽  
Small Series ◽  
Cathode Ray Tube

Abstract OBJECTIVE: The two most recent significant advances in pituitary surgery have been the endonasal endoscopic approach and intraoperative magnetic resonance imaging (IMRI). Each provides improved visualization of intra- and parasellar anatomy with the goal of attaining a complete resection. The combination of the two techniques has not been previously reported in the literature. METHODS: We performed endoscopic, endonasal resection of pituitary macroadenomas in 15 patients using the Polestar N-10 (0.12T) IMRI (Odin Medical Technologies, Inc., Newton, MA). Eleven patients had nonfunctioning tumors, three had acromegaly, and one had a medication-resistant prolactinoma. The effect of the magnetic field on the cathode ray tube screen and the image quality of the IMRI images were assessed. The presence of residual tumor on IMRI was noted and then re-examined with the endoscope. RESULTS: Although the Polestar N-10 is a low Tesla magnet, the IMRI caused significant distortion of the cathode ray tube screen regardless of the viewing angle. This was overcome with the use of a wall-mounted plasma screen. IMRI images were obtained in all cases and were of sufficiently high quality to demonstrate adequate decompression of the optic chiasm and the removal of all suprasellar tumor. In three cases, residual tumor was found with IMRI that was resected endoscopically before the completion of surgery. In four other cases, potential residual tumor was examined endoscopically and found to be normal postoperative change. In eight cases no residual intrasellar tumor was seen on the IMRI. Preresection visual deficits improved in all cases and the insulin-like growth factor levels normalized in two of three cases. There were no delayed cerebrospinal fluid leaks. CONCLUSION: Combining intraoperative endoscopy and IMRI is feasible and distortion of the cathode ray tube screen can be overcome with the use of either a plasma or liquid crystal display screen. Each technology provides complementary information, which can assist the surgeon in safely maximizing the extent of resection. In this small series using a low-field magnet, rates of residual tumor following endoscopic trans-sphenoidal surgery were less than have been reported following microscope-based transsphenoidal surgery.

scholarly journals Do We Need Intraoperative Magnetic Resonance Imaging in All Endoscopic Endonasal Pituitary Adenoma Surgery Cases? A Retrospective Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Emrah Celtikci ◽  
Muammer Melih Sahin ◽  
Mustafa Caglar Sahin ◽  
Emetullah Cindil ◽  
Zuhal Demirtaş ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Pituitary Adenoma ◽  
Magnetic Resonance ◽  
Cavernous Sinus ◽  
Residual Tumor ◽  
Correct Prediction ◽  
Resonance Imaging ◽  
Mri Scan ◽  
Endoscopic Endonasal ◽  
Grade 3

There are previous reports investigating effectiveness of intraoperative magnetic resonance imaging (IO-MRI) in pituitary adenoma surgery but there is no clear data in the literature recommending when there is no need of intraoperative scan. This retrospective analysis was based on determining which patients does not need any IO-MRI scan following endoscopic endonasal pituitary adenoma surgery. Patients with functional or non-functional pituitary adenomas that were operated via endoscopic endonasal approach (EEA) between June 2017 and May 2019 were enrolled. Patients younger than 18 years old, patients who did not underwent IO-MRI procedure or not operated via EEA were excluded from the study. Hence, this study is designed to clarify if IO-MRI is useful in both functional and non-functional pituitary adenomas, functional adenomas did not split into subgroups. A total of 200 patients treated with pituitary adenoma were included. In Knosp Grade 0 – 2 group, primary surgeon’s opinion and IO-MRI findings were compatible in 150 patients (98.6%). In Knosp Grade 3 – 4 correct prediction were performed in 32 (66.6%) patients. When incorrectly predicted Knosp Grade 3 – 4 patients (n = 16) was analyzed, in 13 patients there were still residual tumor in cavernous sinus and in 3 patients there were no residual tumor. Fisher’s exact test showed there is a statistically significant difference of correct prediction between two different Knosp Grade groups (two-tailed P < 0.0001). Eighteen patients had a residual tumor extending to the suprasellar and parasellar regions which second most common site for residual tumor. Our findings demonstrate that there is no need of IO-MRI scan while operating adenomas limited in the sellae and not invading the cavernous sinus. However, we strongly recommend IO-MRI if there is any suprasellar and parasellar extension and/or cavernous sinus invasion.

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.

Intraoperative Magnetic Resonance Imaging in Skull Base Surgery: A Review of 71 Consecutive Cases

2016 ◽  
Vol 93 ◽  
pp. 183-190 ◽  
Author(s):  
Ramsey Ashour ◽  
Stephen Reintjes ◽  
Michael S. Park ◽  
Sananthan Sivakanthan ◽  
Harry van Loveren ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Resonance Imaging ◽  
Intraoperative Magnetic Resonance Imaging
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