Dual-Use Intraoperative MRI in Glioblastoma Surgery: Results of Resection, Histopathologic Assessment, and Surgical Site Infections

Abstract

Background To achieve maximal resection in glioblastoma (GBM) surgery, intraoperative imaging is important. An intraoperative magnetic resonance imaging (iMRI) suite used for both diagnostic and intraoperative imaging is considered being a reasonable concept for modern hospital management. It is still discussed if the dual use increases the risk of surgical site infections (SSI). This article assesses the rate of gross total resection (GTR), extent of resection (EOR), and histopathology after iMRI-guided resections in patients with GBM. The rate of surgical site infections (SSIs) is evaluated. Methods In all, 79 patients with GBM were operated on with iMRI. Additional resection was performed if iMRI depicted contrast enhancing tissue suggestive of residual tumor. GTR and EOR were determined by segmentation and volumetric analysis of the MR images. SSIs and the role of intravenous only or intravenous plus intrathecal antibiotics were evaluated. Statistical analysis was performed to detect the sensitivity, specificity, positive predictive value, and negative predictive value of iMRI-guided extended resections. Pearson's two-tailed chi-square test was performed to evaluate the rates of GTR and variables associated with SSI. Results GTR was achieved in 59 patients (74.68%). Rate of GTR was 35.44% before iMRI and additional resections (p < 0.0001). Mean EOR was 96.27%. Positive predictive value for tumor cells in the additionally resected tissue was 88.6%, negative predictive value was 100%, sensitivity was 100%, and specificity was 70. 6%. Rate of SSIs was 5.06% (n = 4). Two superficial SSIs, one subdural empyema and one cerebritis, were seen. SSI rates with parenteral only and additional intrathecal antibiotics were 0% and 8%, respectively (p = 0.133). Conclusion Increase of extent of tumor resection using iMRI is evident. SSI rate is within the normal range of neurosurgical procedures. A dual-use iMRI suite is a safe concept.

Synthesis and Functionalisation of Superparamagnetic Nano-Rods towards the Treatment of Glioblastoma Brain Tumours

“…All samples and standards showed identical peaks, which appeared due to the release of carnosine without any impurities or structural modification (Figure S12). The SEM-EDS and TEM images enabled the tracking of entry into U87 cells over (1,4,24) hours, and the subcellular release and distribution of the drug that was related to the accumulation of BPEI-coated IONRs in the target organelle nucleus [64,69]. The TEM images represent the autophagy vacuoles in the U87 cells' cytoplasm after 4 h of carnosine treatment, which was similar to that of rapamycin [70].…”

“…In addition, the free carnosine accumulate inside the mitochondria as a dark silhouette. The uptake of carnosine is likely to have taken place during mitosis, whereupon the carnosine was transferred into the daughter cells; however, the full chemical effect of the carnosine was not observed until later in the cell cycle (Figure 15J-M The SEM-EDS and TEM images enabled the tracking of entry into U87 cells over (1,4,24) hours, and the subcellular release and distribution of the drug that was related to the accumulation of BPEI-coated IONRs in the target organelle nucleus [64,69]. The TEM images represent the autophagy vacuoles in the U87 cells' cytoplasm after 4 h of carnosine treatment, which was similar to that of rapamycin [70].…”

“…It is, therefore, imperative to look towards new theragnostic approaches to treat this terminal disease [1,3]. In order to mitigate the risk of residual malignant cells post-surgery, real time medical imaging (e.g., MRI) during surgery is emerging as a new tool for surgeons to help reduce recurrence; however, to optimise this process, a targeted contrast agent is required [4][5][6][7].…”

Intraoperative MRI-guided Resection in Pediatric Brain Tumor Surgery: A Meta-analysis of Extent of Resection and Safety Outcomes

“…39,40 Even in a shared-resource iMRI for diagnostic and intraoperative imaging, the rate of SSI was analyzed to be 5.06% in an adult glioblastoma population and the rate SSI was not significantly increased. 41…”