Intraoperative Magnetic Resonance Imaging for Low-Grade and High-Grade Gliomas: What Is the Evidence? A Meta-Analysis

Lo, Yu Tung; Lee, Hyunkyung; Shui, Cher; Lamba, Nayan; Korde, Rasika; Devi, Sharmila; Chawla, Shreya; Nam, Younjong; Patel, Romel; Doucette, Joanne; Bunevičius, Adomas; Mekary, Rania A.

doi:10.1016/j.wneu.2021.01.089

Cited by 18 publications

(14 citation statements)

References 36 publications

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“…In contrast, Fountain et al 169 published a meta-analysis (including several RCTs, such as those reported by Senft et al 225 and Willems et al 4 ), which revealed that ioMR imaging might help to maximize the extent of resection in patients with high-grade glioma, although this conclusion was based on low-certainty evidence. This supported the findings of a previous review by Jenkinson et al 226 In a recent meta-analysis report by Lo et al, 227 the usage of ioMR imaging led to improved gross total resection of gliomas, but no benefits were seen for progression-free or overall survival.…”

Section: The Impact Of Intraoperative Imaging On Brain Tumor Surgerysupporting

confidence: 88%

Intraoperative MR Imaging during Glioma Resection

2022

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One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motorevoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.

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Section: The Impact Of Intraoperative Imaging On Brain Tumor Surgerysupporting

confidence: 88%

Intraoperative MR Imaging during Glioma Resection

2022

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“…With the optimization and upgrade of medical imaging technology, image fusion technology has been applied in the assessment before and after brain gliomas surgery. This multimodal imaging modality uses computer technology to digitally and comprehensively process the image information acquired from various imaging examinations for multivariate data synergistic use and then generates a brand-new imaging after spatial registration [ 19 , 20 ]. It is beneficial for physicians to understand the comprehensive information of lesion tissues to develop more rational treatment regimens or evaluate the therapeutic effects.…”

Section: Discussionmentioning

confidence: 99%

Effect of 3D Slicer Preoperative Planning and Intraoperative Guidance with Mobile Phone Virtual Reality Technology on Brain Glioma Surgery

Leng

et al. 2022

Contrast Media & Molecular Imaging

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Objective. To explore the effect of 3D Slicer preoperative planning and intraoperative guidance with mobile phone virtual reality (VR) technology on brain glioma surgery. Methods. By means of retrospective study, the data of 77 brain glioma patients treated in the neurosurgery departments at The Second Affiliated Hospital of Wannan Medical College and Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2022 were analyzed, and the patients were divided into the experimental group (EG, n = 38) and the control group (CG, n = 39) according to the surgical modalities. Before surgery, all patients received positron emission tomography-computed tomography (PET/CT) scanning and magnetic resonance imaging (MRI) examination. For patients in EG, the DICOM format images acquired from PET-CT and MRI examinations were imported with the 3D Slicer software for 3D visual fusion reconstruction, acquiring VR images, and developing detailed preoperative planning. Then, the reconstructed images were imported into the Sina software on a mobile phone, and the surgery was performed with the assistance of VR technology; for patients in CG, traditional 2D images were used for tumor contour drawing by the subjective visual method, and the craniotomy was performed under a traditional microscope. Patients’ surgery indicators and Karnofsky Performance Scale (KPS) scores were compared between the two groups. Results. The number of cases with total resection, rate of total resection, hospital stay after surgery, and surgery time were significantly better in EG than in CG ( P < 0.05 ); after treatment, the KPS score was significantly higher in EG than in CG (75.66 ± 4.01 vs 65.36 ± 5.23, P < 0.001 ). Conclusion. Combining 3D Slicer preoperative planning with intraoperative mobile phone VR technology can promote the accuracy of brain glioma surgery, which is conducive to effectively removing tumors while protecting patients’ neural function.

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“…Based on preoperative imaging, and overlap with FMRI-DTI, neuro-navigation allows preoperative identification of eloquent regions and guides the surgeon during intraoperative mapping and tumor resection [ 51 – 56 ] III C iCT: iCT helped to verify EOR and to identify and resect pathological tissue. iCT represents a feasible and effective alternative for intraoperative updates of the neuro-navigation system [ 11 , 57 ] III C iUS: iUS is a real-time, accurate and inexpensive imaging method for optimizing the EOR in neurosurgical interventions Despite being an operator-dependent method, iUS is associated with a greater EOR and improved PFS and OS in glioma patients [ 58 – 60 ] III C iMRI: iMRI was found to be associated with higher resection rates compared to the neuro-navigated procedures, Unfortunately, the high cost and the need for structural changes in the operating room have limited, to date, the spread of intraoperative MRI [ 59 – 64 ] III C 5-ALA: 5-ALA is a metabolic tracer that allows the intraoperative distinction of the boundaries between healthy tissue and tumor near the infiltration zones, thus guiding the glioma resection with an improved intraoperative enhancing vision [ 65 – 72 ] II B Fluorescence: sodium fluorescein (FLCN): The intraoperative guidance determined by FLCN allows to predict histopathological alterations both in areas with contrast enhancement and in the margins of infiltration of the cerebral parenchyma that do not present a neuroimaging contrast [ 60 , 70 , 73 – 76 ] III C Intraoperative treatment options In newly diagnosed HGGs, CWs implantations should not be considered as first-line therapeutic option [ 77 – 81 ] II B Estimation of extent of tumor resection ...…”

Section: Methodsmentioning

confidence: 99%

Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review

et al. 2023

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Purpose The extent of resection (EOR) is an independent prognostic factor for overall survival (OS) in adult patients with Glioma Grade 4 (GG4). The aim of the neuro-oncology section of the Italian Society of Neurosurgery (SINch®) was to provide a general overview of the current trends and technical tools to reach this goal. Methods A systematic review was performed. The results were divided and ordered, by an expert team of surgeons, to assess the Class of Evidence (CE) and Strength of Recommendation (SR) of perioperative drugs management, imaging, surgery, intraoperative imaging, estimation of EOR, surgery at tumor progression and surgery in elderly patients. Results A total of 352 studies were identified, including 299 retrospective studies and 53 reviews/meta-analysis. The use of Dexamethasone and the avoidance of prophylaxis with anti-seizure medications reached a CE I and SR A. A preoperative imaging standard protocol was defined with CE II and SR B and usefulness of an early postoperative MRI, with CE II and SR B. The EOR was defined the strongest independent risk factor for both OS and tumor recurrence with CE II and SR B. For intraoperative imaging only the use of 5-ALA reached a CE II and SR B. The estimation of EOR was established to be fundamental in planning postoperative adjuvant treatments with CE II and SR B and the stereotactic image-guided brain biopsy to be the procedure of choice when an extensive surgical resection is not feasible (CE II and SR B). Conclusions A growing number of evidences evidence support the role of maximal safe resection as primary OS predictor in GG4 patients. The ongoing development of intraoperative techniques for a precise real-time identification of peritumoral functional pathways enables surgeons to maximize EOR minimizing the post-operative morbidity.

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Intraoperative Magnetic Resonance Imaging for Low-Grade and High-Grade Gliomas: What Is the Evidence? A Meta-Analysis

Cited by 18 publications

References 36 publications

Intraoperative MR Imaging during Glioma Resection

Intraoperative MR Imaging during Glioma Resection

Effect of 3D Slicer Preoperative Planning and Intraoperative Guidance with Mobile Phone Virtual Reality Technology on Brain Glioma Surgery

Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review

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