Intra-operative 3.0 T Magnetic Resonance Imaging Using a Dual-Independent Room: Long-Term Evaluation of Time-Cost, Problems, and Learning-Curve Effect

Martin, Xavier Pablos; Vaz, G.; Fomekong, Edward; Cosnard, Guy; Raftopoulos, Christian

doi:10.1007/978-3-211-99651-5_21

Cited by 4 publications

(3 citation statements)

References 30 publications

(36 reference statements)

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“…The extent of resection (EOR), which can be improved by ioMRI, is significantly linked to the survival duration of patients suffering from GBM [8,11,[13][14][15]. Despite this substantial advantage, the impact of ioMRI on surgery in terms of costs and time loss has also been highlighted by several authors [14,18,[25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 97%

Glioblastoma surgery with and without intraoperative MRI at 3.0T

et al. 2014

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Section: Introductionmentioning

confidence: 97%

Glioblastoma surgery with and without intraoperative MRI at 3.0T

et al. 2014

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“…Intraoperative MRI suites surely provide the best visualization of the spinal cord structures, but it resembles a quite expensive and time-consuming modality. 13 Furthermore, the method has its limitations after ACDF-procedures because of artifacts of implanted cages, especially in operations with additional anterior plating. Also, intraoperative ultrasound is deviously limited in visualizing structures dorsal the vertebral bodies; it may provide information about the spinal cord after amplified ventral exposure via corpectomy, but especially in degenerative spinal cord compression with ossified posterior longitudinal ligament, it has limited utility due to artifacts from residual ossification and limitation by the bony exposure.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Intraoperative Computed Tomography in Complication Management after Spine Surgery

Kerschbaumer

Freyschlag

Seiz-Rosenhagen

et al. 2015

IJNS

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Intraoperative computed tomographic (CT) scanners are used frequently in spine surgery for exact pedicle screw placement. In complication management, imaging is mainly used outside the operation theater. A 69-year-old female patient with progressive cervical radiculopathy and myelopathy due to spinal stenosis at C4/5 and C5/6 underwent two-level anterior decompression and fusion uneventfully. Shortly after surgery the patient developed a rapid loss of motor function in the upper and lower limbs, followed by a rising sensory deficit. A cage dislocation or an epidural hematoma was suspected and immediate surgical decompression was warranted. A CT scan was performed using an intraoperative CT right after reintubation. It showed an extensive epidural hematoma ranging from C2 to C4. A reoperation and removal of the hematoma was performed via a C5 corpectomy, extended to a C4?C5 corpectomy due to persistent compression demonstrated on a second intraoperative CT. After the revision operation the patient presented with only a minimal paraparesis of the lower limbs, declining over the next 2 weeks. A magnetic resonance imaging scan is usually requested in case of a new neurological deficit after cervical spine surgery to detect an epidural hematoma or edema of the spinal cord. Normal neurological examination after extubation followed by rapid progressive deterioration is most likely suspicious to be caused by a hematoma compressing the spinal cord. In the presented case, a CT scan in the operation theater provides adequate imaging information at short hand, aiding the surgeon to perform an emergency revision operation.

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“…Despite the unquestionable advantages of iMRI regarding an increased rate of GTR, [14][15][16][17] its high costs in terms of money and time are reasons for its reduced availability in neurosurgical centers. [18][19][20] Therefore, FG resection is mostly performed in Europe. As mentioned before, fluorescent tissue is mainly dependent on adequate exposure to blue light, which can be limited using microscopic fluorescence guidance.…”

Section: Volumetric Measurementsmentioning

confidence: 99%

Endoscope-assisted fluorescence-guided resection allowing supratotal removal in glioblastoma surgery

Bettag¹,

Schregel

Langer

et al. 2021

Neurosurgical Focus

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OBJECTIVESeveral studies have proven the benefits of a wide extent of resection (EOR) of contrast-enhancing tumor in terms of progression-free survival (PFS) and overall survival (OS) in patients with glioblastoma (GBM). Thus, gross-total resection (GTR) is the main surgical goal in noneloquently located GBMs. Complete tumor removal can be almost doubled by microscopic fluorescence guidance. Recently, a study has shown that an endoscope with a light source capable of inducing fluorescence allows visualization of remnant fluorescent tumor tissue even after complete microscopic fluorescence-guided (FG) resection, thereby increasing the rate of GTR. Since tumor infiltration spreads beyond the borders of contrast enhancement on MRI, the aim of this study was to determine via volumetric analyses of the EOR whether endoscope-assisted FG resection enables supratotal resection beyond the borders of contrast enhancement.METHODSThe authors conducted a retrospective single-center analysis of a consecutive series of patients with primary GBM presumed to be noneloquently located and routinely operated on at their institution between January 2015 and February 2018 using a combined microscopic and endoscopic FG resection. A 20-mg/kg dose of 5-aminolevulinic acid (5-ALA) was administered 4 hours before surgery. After complete microscopic FG resection, the resection cavity was scanned using the endoscope. Detected residual fluorescent tissue was resected and embedded separately for histopathological examination. Nonenhanced and contrast-enhanced 3D T1-weighted MR images acquired before and within 48 hours after tumor resection were analyzed using 3D Slicer. Bias field–corrected data were used to segment brain parenchyma, contrast-enhancing tumor, and the resection cavity for volume definition. The difference between the pre- and postoperative brain parenchyma volume was considered to be equivalent to the resected nonenhancing but fluorescent tumor tissue. The volume of resected tumor tissue was calculated from the sum of resected contrast-enhancing tumor tissue and resected nonenhancing tumor tissue.RESULTSTwelve patients with GBM were operated on using endoscopic after complete microscopic FG resection. In all cases, residual fluorescent tissue not visualized with the microscope was detected. Histopathological examination confirmed residual tumor tissue in all specimens. The mean preoperative volume of brain parenchyma without contrast-enhancing tumor was 1213.2 cm3. The mean postoperative volume of brain parenchyma without the resection cavity was 1151.2 cm3, accounting for a mean volume of nonenhancing but fluorescent tumor tissue of 62.0 cm3. The mean relative rate of the overall resected volume compared to the contrast-enhancing tumor volume was 244.7% (p < 0.001).CONCLUSIONSCombined microscopic and endoscopic FG resection of GBM significantly increases the EOR and allows the surgeon to achieve a supratotal resection beyond the borders of contrast enhancement in noneloquently located GBM.

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Intra-operative 3.0 T Magnetic Resonance Imaging Using a Dual-Independent Room: Long-Term Evaluation of Time-Cost, Problems, and Learning-Curve Effect

Cited by 4 publications

References 30 publications

Glioblastoma surgery with and without intraoperative MRI at 3.0T

Glioblastoma surgery with and without intraoperative MRI at 3.0T

Usefulness of Intraoperative Computed Tomography in Complication Management after Spine Surgery

Endoscope-assisted fluorescence-guided resection allowing supratotal removal in glioblastoma surgery

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