Information-Guided Surgical Management of Gliomas Using Low-Field-Strength Intraoperative MRI

Abstract

Information-guided management of gliomas using low-field-strength ioMRI provides a good opportunity for maximal possible tumor resection, and may result in survival advantage, particularly in patients with WHO grade III neoplasms.

Patterns of Intracranial Glioblastoma Recurrence After Aggressive Surgical Resection and Adjuvant Management: Retrospective Analysis of 43 Cases

“…Such beneficial results may reflect the advantages of our treatment concept of information-guided surgery for brain tumors based on the constant use of advanced intraoperative technologies. 17,28,30) Our surgical strategy for information-guided management of intracranial gliomas with the use of iMR imaging has been described in detail elsewhere. 27,28,30) It is based on the integration of various intraoperative anatomical, functional, and histological data to attain maximal surgical resection of the tumor with minimal risk of postoperative neurological morbidity.…”

“…In our practice, the procedure is usually directed to the maximal possible resection of the enhanced area in cases of high-grade glioma, which might be radiologically total as well as subtotal, leaving the residual lesion within the functioning eloquent brain structures identified with neurophysiological monitoring and/or brain mapping. 27,28,30) In the majority of reported series, local progression of intracranial glioblastoma after initial 36) 31 Overall 10 patients underwent total surgical resection; In 10 cases maximal tumor removal followed by FRT (59.4-60.0 Gy) with concurrent and adjuvant TMZ was done; 12 patients were treated with intracavitary brachytherapy after maximal surgical debulking followed by FRT (45 Gy) with concurrent and adjuvant TMZ; 9 patients had unresectable disease and underwent hypofractionated radiotherapy (50-66 Gy in 10 fractions) followed by adjuvant TMZ or bevacizumab median 12.6; range 3.5-50.6 100% 52%…”

“…Case selection was limited to the beginning of 2004, since the initial period after installation of iMR imaging in our clinic (2000) was completed by this time, significant improvement of the intraoperative image quality had succeeded, and the surgical algorithm of glioma treatment in this facility was fully established. 16,27,28,30) All selected cases were checked for resection rate. The established cut-off level of 95% or greater tumor removal was chosen, because this value corresponds to the grading of resection of malignant gliomas used by The Committee of Brain Tumor Registry of Japan.…”

“…Tumor removal was performed according to our concept of information-guided surgery 17,28,30) with the use of iMR imaging, updated neuronavigation, comprehensive neurophysiological monitoring, neurochemical monitoring with 5-aminolevulinic acid (5-ALA), and histopathological monitoring with multiple microscopic investigations of the resected tissue using frozen sections. Awake craniotomy and/or intraoperative cortical and subcortical brain mapping were performed if indicated.…”

“…Contemporary advances in neurosurgical technique and introduction of modern intraoperative technologies now permit attain gross total resection of the brain tumor in many cases. 16,19,24,28,30,39,45) Surgical treatment in the vast majority of gliomas could not be considered as curative, but more complete removal of the localized part of the neoplasm may change the dynamics of further growth and Y. Konishi et al related prognosis. 11,31) The present retrospective analysis tried to evaluate the recurrence patterns of intracranial glioblastomas after aggressive surgery.…”