Combined Brain Mapping and Compact Intraoperative MRI for Brain Tumor Resection

Abstract

Background: Surgery on patients with lesions in the dominant hemisphere for language is best done with awake language mapping. Intraoperative MRI (iMRI) has also been proposed as an ideal method for tumor resection control in patients with primary brain tumors. Objectives: This study examines the feasibility of low-field iMRI during awake craniotomy and tumor resection. Methods: 36 patients underwent awake resection with a compact iMRI for guidance. Outcomes were grouped using an A–D classification. Outcome A was defined as gross total resection (GTR) without iMRI, B as GTR achieved secondary to iMRI findings, C as resection stopped due to mapping but prior to iMRI, and, finally, D as resection stopped after iMRI had showed residual tumor but subsequent mapping limited further resection. Results: Diagnoses included primary brain tumors in all but 2 patients: 1 had mesial temporal sclerosis and 1 cysticercosis. Overall, outcomes A and D were the most common with 12 patients each, outcome C was the least common occurring in only 3 patients, and outcome B occurred in 9 patients. Hence, in 12 patients, iMRI led to increased tumor resection while in another 12 brain mapping limited the extent of resection. Conclusions: Combined awake language and motor mapping and iMRI guidance is feasible for resection of brain lesions. A compact iMRI has unique advantages for this approach.

Impact of combined use of intraoperative MRI and awake microsurgical resection on patients with gliomas: a systematic review and meta-analysis

“…This has been reported in 11 studies, including 410 patients (Fig. 4) [12,22,24,26,30,31,54,56,58,59,61].…”

“…The rate of patients who underwent supplementary resection after one or several IoMRI was 46% (range 39.8-52.2; I^2 = 8.49%, P heterogeneity = 0.364, standard error = 0.032, p < 0.001). This has been reported in 8 studies, including 255 patients [12,22,24,26,30,56,58,59]. Moreover, the increment of complete resection after IoMRI was clearly reported in few studies [24,26,61].…”

“…The mean duration of surgery was 6.3 hours (median 7.05, range 3.8-7.9). This has been reported on 6 studies, including 144 patients [22,26,30,54,56,58].…”

Usefulness of Intraoperative 2D-Ultrasound in the Resection of Brain Tumors

“…Intraoperative navigation has become the standard practice for initial localization and evaluation of tumor margins during resection [20]. However, navigation may be limited by changes in the arrangement of brain tissue during the procedure due to inflammation, tumor resection, CSF drainage, among other factors.…”

Intraoperative Ultrasound: An Easy, Cost-Effective Method in Neurosurgical Tumor Resection

“…Ancak bazı tümörler subkortikal veya tahmini daha güç şekilde yerleşir ki cerrah peroperatif olarak lezyonu bulmakta zorluk yaşayabilir. Bu gibi durumların üstesinde gelmek adına intraoperatif tomografi, intraoperatif MRG ve navigasyon sistemleri ile ameliyat yöntemleri geliştirilmiş ve bazı sınırlı sayıda merkezde güvenle kullanılmaktadır (10)(11)(12)(13)(14) . Bu yöntemler nöroşirürji tarihinde önemli bir dönüm noktası olarak görülüyor olsa da sistemlerin pahalı oluşu nedeniyle çok kısıtlı sayıda merkez bu cihazlara erişebilmektedir.…”