1.5 Tesla field intraoperative MRI improves extent of resection and survival in glioblastoma removal.

1.5 Tesla field intraoperative MRI improves extent of resection and survival in glioblastoma removal.

World Neurosurg. 2016 Nov 9;:

Authors: Marongiu A, Familiari P, D'Andrea G, Pesce A, Frati A, Raco A

Abstract
OBJECTIVE: Gross total resection (GTR) of glioblastoma may be achieved with the aid of intraoperative magnetic resonance imaging (Io-MRI), which detects residual tumor during surgery, with the aim of maximizing resection, thus reducing the risk of recurrence. Moreover, intraoperative fiber tracking and neuronavigated electrophysiological cortical and subcortical mapping may help prevent postoperative deficits.
METHODS: 114 patients underwent surgical removal of newly diagnosed supratentorial glioblastoma between January 2009 and January 2013: 78 (group A) were operated on with the aid of Io-MRI and 36 without (group B). The protocol included preoperative and intraoperative MRI with diffusion tensor imaging (DTI) in all the cases that presented eloquent areas of involvement. The Extent of Resection (EOR) was compared in the two groups 24-72 hours after surgery.
RESULTS: The first Io-MRI detected a GTR in 31 patients (39.7%) and a residual tumor in 47 patients (60.3%) belonging to group A. Twenty-one patients had residual tumor within eloquent areas: Io-MRI with fibre tracking permitted further resection, achieving GTR in 12 patients. GTR was radiologically detected in the remaining 26 patients (33.3% of group A) who had residual tumor in non-eloquent areas after one or two further resection extensions. Io-MRI enhanced both EOR and 6 moths PFS: the overall GTR for group A amounted to 88.5% (69 patients), while for group B was 44% (16 patients). Six-month-Progression Free Survival (6-PFS) accounted for 73% (57 patients) of group A and 38.9% (14 patients) for group B respectively.
CONCLUSIONS: Our experience suggests that Io-MRI may lead to EOR optimization and associated 6-PFS improvement.

PMID: 27838425 [PubMed - as supplied by publisher]

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