Intraoperative MRI to guide the resection of primary supratentorial glioblastoma multiforme—a quantitative radiological analysis

Schneider, J.; Trantakis, C.; Rubach, Matthias; Schulz, Thomas; Dietrich, J; Winkler, Dirk; Renner, C; Schober, R.; Geiger, Kathrin; Brosteanu, Oana; Zimmer, Claus; Kahn, Thomas

doi:10.1007/s00234-005-1397-1

Cited by 136 publications

(58 citation statements)

References 52 publications

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“…2,3,[11][12][13][14]18,[22][23][24] In some earlier work we showed that intraoperative multimodality electrophysiological mapping can be seamlessly incorporated into high-field iMRI for tumor resections. 15 Initially when we started the procedure of combining awake craniotomy with high-field iMRI, there were a number of challenges to overcome, including patient comfort and position as well as new draping and anesthetic techniques unique to the iMRI environment.…”

Section: Discussionmentioning

confidence: 99%

Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

Maldaun¹,

Khawja²,

Levine³

et al. 2014

JNS

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Object. The object of this study was to describe the experience of combining awake craniotomy techniques with high-field (1.5 T) intraoperative MRI (iMRI) for tumors adjacent to eloquent cortex.Methods. From a prospective database the authors obtained and evaluated the records of all patients who had undergone awake craniotomy procedures with cortical and subcortical mapping in the iMRI suite. The integration of these two modalities was assessed with respect to safety, operative times, workflow, extent of resection (EOR), and neurological outcome.Results. Between February 2010 and December 2011, 42 awake craniotomy procedures using iMRI were performed in 41 patients for the removal of intraaxial tumors. There were 31 left-sided and 11 right-sided tumors. In half of the cases (21 [50%] of 42), the patient was kept awake for both motor and speech mapping. The mean duration of surgery overall was 7.3 hours (range 4.0-13.9 hours). The median EOR overall was 90%, and gross-total resection (EOR ≥ 95%) was achieved in 17 cases (40.5%). After viewing the first MR images after initial resection, further resection was performed in 17 cases (40.5%); the mean EOR in these cases increased from 56% to 67% after further resection. No deficits were observed preoperatively in 33 cases (78.5%), and worsening neurological deficits were noted immediately after surgery in 11 cases (26.2%). At 1 month after surgery, however, worsened neurological function was observed in only 1 case (2.3%).Conclusions. There was a learning curve with regard to patient positioning and setup times, although it did not adversely affect patient outcomes. Awake craniotomy can be safely performed in a high-field (1.5 T) iMRI suite to maximize tumor resection in eloquent brain areas with an acceptable morbidity profile at 1 month. (http://thejns.org/doi/abs/10.3171/2014.6.JNS132285) Key words • awake craniotomy • cortical mapping • glioma surgery • iMRI • EOR • oncologyAbbreviations used in this paper: DTI = diffusion tensor imaging; DWI = diffusion-weighted imaging; EOR = extent of resection; fMRI = functional MRI; GTR = gross-total resection; iMRI = intraoperative MRI; LMA = laryngeal mask airway; OR = operating room; PR = partial resection; STR = subtotal resection.

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Section: Discussionmentioning

confidence: 99%

Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

Maldaun¹,

Khawja²,

Levine³

et al. 2014

JNS

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“…Consequently, efforts have been made in recent years to integrate DTI data with neurosurgical navigation systems , Coenen et al 2003, Talos et al 2003, Berman et al 2004, Shinoura et al 2005, Nimsky et al 2006. Such a study on the role of diffusion tensor imaging of the corticospinal tract (CST) before and after mass resection, and the correlations with clinical motor findings, was recently published by Laundre et al 2005. Interventional MRI (iMRI) has proven to be an effective tool for improving the completeness of low grade glioma resection (Claus et al 2005, Bradley 2002, Schneider et al 2001, Schneider et al 2005, Knauth et al 1999, Wirtz et al 2000. However, brain deformations typically occur during the neurosurgical procedure, which results in a misalignment between the pre-operatively acquired datasets and the intraoperative brain position.…”

Section: Introductionmentioning

confidence: 99%

Non-rigid alignment of pre-operative MRI, fMRI, and DT-MRI with intra-operative MRI for enhanced visualization and navigation in image-guided neurosurgery

et al. 2007

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Objective-The usefulness of neurosurgical navigation with current visualizations is seriously compromised by brain shift, which inevitably occurs during the course of the operation, significantly degrading the precise alignment between the preoperative MR data and the intraoperative shape of the brain. Our objectives were (i) to evaluate the feasibility of non-rigid registration that compensates for the brain deformations within the time constraints imposed by neurosurgery, and (ii) create augmented reality visualizations of critical structural and functional brain regions during neurosurgery using pre-operatively acquired fMRI and DT-MRI.Materials and Methods-Eleven consecutive patients with supratentorial gliomas were included in our study. All underwent surgery at our intra-operative MR imaging-guided therapy facility and have tumors in eloquent brain areas (e.g. precentral gyrus and cortico-spinal tract). Functional MRI and DT-MRI, together with MPRAGE and T2w structural MRI were acquired at 3T prior to surgery. SPGR and T2w images were acquired with a 0.5T magnet during each procedure. Quantitative assessment of the alignment accuracy was carried out and compared with current state-of the-art systems based only on rigid-registration.Results-Alignment between preoperative and intra-operative datasets was successfully carried out during surgery for all patients. Overall, the mean residual displacement remaining after nonrigid registration was 1.82 mm. There is a statistically significant improvement in alignment accuracy utilizing our non-rigid registration in comparison to the currently used technology (p<0.001).Conclusions-We were able to achieve intra-operative rigid and non-rigid registration of (1) pre-operative structural MRI with intra-operative T1w MRI; (2) pre-operative FMRI with intraoperative T1w MRI, and (3) pre-operative DT-MRI with intra-operative T1w MRI. The registration algorithms as implemented were sufficiently robust and rapid to meet the hard realtime constraints of intra-operative surgical decision making. The validation experiments demonstrate that we can accurately compensate for the deformation of the brain and thus can construct an augmented reality visualization to aid the surgeon.

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“…15,16,25,38) The findings of intraoperative imaging modified the surgical strategy in 71.1% of patients with gliomas, the highest among our cases of brain tumors, indicating that glioma surgery was the best indication.…”

Section: Discussionmentioning

confidence: 78%

Clinical Indications for High-Field 1.5 T Intraoperative Magnetic Resonance Imaging and Neuro-navigation for Neurosurgical Procedures -Review of Initial 100 Cases-

Maesawa

Fujii

Nakahara

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Initial experiences are reviewed in an integrated operation theater equipped with an intraoperative high-field (1.5 T) magnetic resonance (MR) imager and neuro-navigation (BrainSUITE  ), to evaluate the indications and limitations. One hundred consecutive cases were treated, consisting of 38 gliomas, 49 other tumors, 11 cerebrovascular diseases, and 2 functional diseases. The feasibility and usefulness of the integrated theater were evaluated for individual diseases, focusing on whether intraoperative images (including diffusion tensor imaging) affected the surgical strategy. The extent of resection and outcomes in each histological category of brain tumors were examined. Intraoperative high-field MR imaging frequently affected or modified the surgical strategy in the glioma group (27/38 cases, 71.1%), but less in the other tumor group (13/49 cases, 26.5%). The surgical strategy was not modified in cerebrovascular or functional diseases, but the success of procedures and the absence of complications could be confirmed. In glioma surgery, subtotal or greater resection was achieved in 22 of the 31 patients (71%) excluding biopsies, and intraoperative images revealed tumor remnants resulting in the extension of resection in 21 of the 22 patients (95.4%), the highest rate of extension among all types of pathologies. The integrated neuro-navigation improved workflow. The best indication for intraoperative high-field MR imaging and integrated neuro-navigation is brain tumors, especially gliomas, and is supplementary in assuring quality in surgery for cerebrovascular or functional diseases. Immediate quality assurance is provided in several types of neurosurgical procedures.

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Intraoperative MRI to guide the resection of primary supratentorial glioblastoma multiforme—a quantitative radiological analysis

Cited by 136 publications

References 52 publications

Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

Non-rigid alignment of pre-operative MRI, fMRI, and DT-MRI with intra-operative MRI for enhanced visualization and navigation in image-guided neurosurgery

Clinical Indications for High-Field 1.5 T Intraoperative Magnetic Resonance Imaging and Neuro-navigation for Neurosurgical Procedures -Review of Initial 100 Cases-

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