The Significance of Intraoperative Magnetic Resonance Imaging in Resection of Skull Base Chordomas

Metwali, Hussam; Samii, Amir; Gerganov, Venelin M.; Giordano, Mario; Fahlbusch, Rudolf; Samii, Madjid

doi:10.1016/j.wneu.2019.04.086

Cited by 9 publications

(17 citation statements)

References 37 publications

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“…Total tumor resection has been shown to be the most important factor in progression-free survival and overall survival in skull base chordomas (4)(5)(6)(7)(8)16). Controversy over aggressive tumor resection in skull base chordomas arises from the tumor's relationship to critical neurovascular structures and that total resection often results in significant morbidity (2,7,8).…”

Section: Discussionmentioning

confidence: 99%

“…Tumor diameter and aggressive growth pattern, previous surgery and radiation therapy have been found to be associated with postoperative morbidity rates (7,8,17,18). Although modern skull base techniques implemented in experienced centers have reduced the mortality and morbidity associated with chordoma resection, chordomas are considered to be tumors that cannot be curable surgically (2,(4)(5)(6)17).…”

Section: Discussionmentioning

confidence: 99%

“…Also, some studies showed that some tumor biological features, such as histological factors, Ki 67 labeling index, chromosomal abnormalities may affect survival (10,11). Chordomas show varying degrees of radioresistance and a tendency to recurrence, so total tumor resection prolongs progression-free survival (1,(4)(5)(6)(7)(8)10).…”

Section: Introductionmentioning

confidence: 99%

“…Chordoma is an uncommon, locally aggressive tumor originating from remnants of the primitive notochordal tissue along the cranial-spinal axis, which accounts 1% to 4% of all bone malignancies and constitutes 0.1% to 0.2% of all primary intracranial neoplasms ( 1 – 4 ). Approximately 35% of chordomas occur in the skull base predominantly in the clivus, cavernous sinus, and petrous apex ( 1 , 3 , 4 ). Cranial base chordomas are often indolent lesions because of their typically slow growth pattern ( 1 – 3 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

“…They progress by infiltrating the low-resistance areas of the bone so cause the local destruction of the anatomic markers ( 1 – 3 , 5 ). They may also envelop or compress the dura and other neurovascular structures adjacent to the tumor site, thereby causing brain stem or cranial nerve symptoms ( 1 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Magnetic Resonance Imaging Assisted Endoscopic Endonasal Resection of Clival Chordomas

et al. 2022

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BackgroundCranial base chordomas are typically indolent and usually appear as encapsulated tumors. They slowly grow by infiltrating the bone, along with the lines of least resistance. Due to its relationship with important neurovascular structures, skull base chordoma surgery is challenging.ObjectiveThe usefulness of intraoperative magnetic resonance imaging (IO-MRI) in achieving the goal of surgery, is evaluated in this study.MethodsBetween March 2018 and March 2020, 42 patients were operated on for resection of skull base chordomas in our institution. All of them were operated on under IO-MRI. Patients were analyzed retrospectively for identifying common residue locations, complications and early post-operative outcomes.ResultsIn 22 patients (52,4%) gross total resection was achieved according to the final IO-MRI. In 20 patients (47,6%) complete tumor removal was not possible because of extension to the petrous bone (8 patients), pontocerebellar angle (6 patients), prepontine cistern (4 patients), temporobasal (1 patient), cervical axis (1 patient). In 13 patients, the surgery was continued after the first IO-MRI control was performed, which showed a resectable residual tumor. 7 of these patients achieved total resection according to the second IO-MRI, in the other 6 patients all efforts were made to ensure maximal resection of the tumor as much as possible without morbidity. Repeated IO-MRI helped achieve gross total resection in 7 patients (53.8%).ConclusionsOur study proves that the use of IO-MRI is a safe method that provides the opportunity to show the degree of resection in skull base chordomas and to evaluate the volume and location of the residual tumor intraoperatively. Hence IO-MRI can improve the life expectancy of patients because it provides an opportunity for both gross total resection and maximal safe resection in cases where total resection is not possible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intraoperative Magnetic Resonance Imaging Assisted Endoscopic Endonasal Resection of Clival Chordomas

et al. 2022

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Endoscopic Resection of Clival Chordoma

Fountain

Anwar

Muquit

et al. 2021

Rhinology and Anterior Skull Base Surgery

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Intraoperative magnetic resonance imaging in glioma surgery: a single-center experience

Mirzayeva,

Uçar,

Kaymaz

et al. 2024

J Neurooncol

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Purpose To investigate the effect of intraoperative magnetic resonance imaging (Io MRI) on overall and progression-free survival (OS and PFS), on the extent of resection (EOR) in patients with glioma, and impact of the radiological diagnosis on the decision to continue the surgery when a residual mass was detected on Io MRI. Methods The study comprised 153 glioma patients who received surgical treatment between 2013 and 2023. One-hundred twenty-five of them had Io MRI guidance during surgery. The remainder 28 patients constituted the control group who did not undergo Io MRI. All patients' age at surgery, gender, initial radiological diagnosis, primary tumor localization, EOR, last histopathological diagnosis, and the follow-up periods were recorded. Results The rate of tumor recurrence in Io MRI cases was significantly lower compared to the cases in the control group (p < .0001). It was decided to continue the operation in 45 Io MRI applied cases. This raised the gross total resection (GTR) rate from 33.6% to 49.6% in the Io MRI group. The frequency of GTR was significantly higher in patients with an initial radiological diagnosis of low grade glioma than those with high grade glioma. The shortest OS was seen in occipital gliomas. Conclusion In this study, the convenience provided by the high-field MRI device was explored and proven both in reducing the tumor burden, increasing the PFS, and providing the surgeon with a maximal resection in the first operation.

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The Significance of Intraoperative Magnetic Resonance Imaging in Resection of Skull Base Chordomas

Cited by 9 publications

References 37 publications

Intraoperative Magnetic Resonance Imaging Assisted Endoscopic Endonasal Resection of Clival Chordomas

Intraoperative Magnetic Resonance Imaging Assisted Endoscopic Endonasal Resection of Clival Chordomas

Endoscopic Resection of Clival Chordoma

Intraoperative magnetic resonance imaging in glioma surgery: a single-center experience

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