Influence of iMRI-Guidance on the Extent of Resection and Survival of Patients with Glioblastoma Multiforme

Abstract

Intraoperative MRI (iMRI) is used in glioma surgery mainly to determine the extent of resection, allowing surgeons to immediately continue resection in case of residual tumor tissue. The aim of this study is to report on the influence of the use of iMRI on the extent of resection and survival of patients with glioblastoma multiforme (GBM). We analyzed our prospectively collected database of patients with GBM operated upon during the initial period after installation of an iMRI; between July 2004 and December 2005, all patients with GBM undergoing intended complete tumor resection were included in this study, while patients undergoing mere tumor biopsy or intended incomplete resection were not. In total, 43 Patients met the inclusion criteria. Of these, 10 patients (23.3%) were operated upon with the help of iMRI while 33 underwent conventional tumor resection. All patients underwent postoperative high-field MR imaging at 1.5 Tesla to determine the extent of resection. Subsequently, all patients received adjuvant treatment. Median patient age was 60.0 years; median overall survival was 70.7 weeks. Radiologically complete tumor resection (P < 0.001) and the administration of temozolomide chemotherapy (P < 0.01) were statistically significant prognostic factors in a multivariate analysis. The rate of complete tumor resections was significantly higher in the iMRI group than in the conventional surgery group (P < 0.05). Patient age was not a prognostic factor in our series of patients (P = 0.22). Intraoperative MRI is a helpful tool to increase the extent of resection in GBM surgery and thereby improve patient survival.

Extended Adjuvant Temozolomide with cis-Retinoic Acid for Adult Glioblastoma

“…The extent of surgical resection was not a statistically significant predictor of survival, and yet there was a very strong trend in favor of resection compared with biopsy (p = 0.06). That finding is consistent with the existing literature on surgical resection for adult glioma, although no randomized data are available to support a causal effect [27][28][29][30] . It remains possible that some of the effect is a result of very poor survival in patients in whom surgical resection was not possible.…”

Innovative Surgical Management of Glioma

“…In 2010, Senft and colleagues reported on 41 patients with glioblastoma, 10 of whom underwent resection with iMRI and 31 who received resection by conventional means 17 . GTR was seen in all 10 iMRI cases and 19 of the conventional group.…”

Neurosurgical Management of Gliomas

“…Intraoperative MRI is a tool aimed at maximising tumour resection. Although intraoperatine MRI has been shown to improve the percentage of tumour resected, its use can be very timeconsuming and there is currently no data available to show improved survival benefit (Senft et al, 2010). The different histological subtypes of grade II gliomas are described in table 1.…”