Henri-Arthur Leroy1,2, Christine Delmaire3, Emilie Le Rhun4, Elodie Drumez5, Jean-Paul Lejeune4, Nicolas Reyns4,6. 1. Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France. henriarthurleroy@gmail.com. 2. Inserm, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Univ. Lille, F-59000, Lille, France. henriarthurleroy@gmail.com. 3. Department of Radiology, CHU Lille, F-59000, Lille, France. 4. Department of Neurosurgery and Neuro-oncology, CHU Lille, F-59000, Lille, France. 5. CHU Lille, Department of Biostatistics, EA 2694 - Santé publique: épidémiologie et qualité des soins, Univ. Lille, F-59000, Lille, France. 6. Inserm, CHU Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, Univ. Lille, F-59000, Lille, France.
Abstract
BACKGROUND: High-field intraoperative MRI (IoMRI) is part of the neurosurgical armamentarium to improve the extent of glioma resection (EOR). OBJECTIVE: To report our oncological and functional outcomes using IoMRI for neuronavigated glioma surgery. METHODS: In this prospective monocentric study, we reported 100 consecutive adult patients operated on for glioma using IoMRI with neuronavigation, under general anesthesia without intraoperative stimulation, from July 2014 to April 2017. The volumetric evaluation was based on the FLAIR hypersignal for non-enhancing tumors after Gadolinium infusion and on the T1 hypersignal after Gadolinium infusion for enhancing tumors. We evaluated the surgical workflow, the EOR and the clinical outcomes (using Karnofsky performance score (KPS)). RESULTS: Sixty-nine patients underwent one IoMRI, and 31 from two IoMRI controls. At first IoMRI, the median tumor residue was higher in the FLAIR group than in the T1G+ group whereas no more difference was reported after the second IoMRI between the 2 groups (p = 0.56). Additional resection was performed 6 times more frequently in the FLAIR group (OR = 5.7, CI (1.9-17)). The median EOR was 100% (IQR, 93.6-100) whatever the tumor type (first surgery or recurrence) and location. Higher residues were reported only in the insula area (p = 0.004). The median KPS was 90 (IQR, 80-100) at discharge, 3, 6 and 12 months after surgery, with no statistical difference between low- and high-grade gliomas (p = 0.34). CONCLUSION: IoMRI neuronavigated surgery provided maximal EOR whatever the type of glioma and location. IoMRI was all the more useful for non- or minimally enhancing tumors. The step by step surgical resection, introducing the concept of "staged volume" surgery, ensured a high security for the surgeon and low permanent morbidity for the patients.
BACKGROUND: High-field intraoperative MRI (IoMRI) is part of the neurosurgical armamentarium to improve the extent of glioma resection (EOR). OBJECTIVE: To report our oncological and functional outcomes using IoMRI for neuronavigated glioma surgery. METHODS: In this prospective monocentric study, we reported 100 consecutive adult patients operated on for glioma using IoMRI with neuronavigation, under general anesthesia without intraoperative stimulation, from July 2014 to April 2017. The volumetric evaluation was based on the FLAIR hypersignal for non-enhancing tumors after Gadolinium infusion and on the T1 hypersignal after Gadolinium infusion for enhancing tumors. We evaluated the surgical workflow, the EOR and the clinical outcomes (using Karnofsky performance score (KPS)). RESULTS: Sixty-nine patients underwent one IoMRI, and 31 from two IoMRI controls. At first IoMRI, the median tumor residue was higher in the FLAIR group than in the T1G+ group whereas no more difference was reported after the second IoMRI between the 2 groups (p = 0.56). Additional resection was performed 6 times more frequently in the FLAIR group (OR = 5.7, CI (1.9-17)). The median EOR was 100% (IQR, 93.6-100) whatever the tumor type (first surgery or recurrence) and location. Higher residues were reported only in the insula area (p = 0.004). The median KPS was 90 (IQR, 80-100) at discharge, 3, 6 and 12 months after surgery, with no statistical difference between low- and high-grade gliomas (p = 0.34). CONCLUSION: IoMRI neuronavigated surgery provided maximal EOR whatever the type of glioma and location. IoMRI was all the more useful for non- or minimally enhancing tumors. The step by step surgical resection, introducing the concept of "staged volume" surgery, ensured a high security for the surgeon and low permanent morbidity for the patients.
Authors: Stefanos Voglis; Timothy Müller; Christiaan H B van Niftrik; Lazar Tosic; Marian Christoph Neidert; Luca Regli; Oliver Bozinov Journal: Neurosurg Rev Date: 2020-09-30 Impact factor: 3.042
Authors: Constantin Tuleasca; Henri-Arthur Leroy; Iulia Peciu-Florianu; Ondine Strachowski; Benoit Derre; Marc Levivier; Michael Schulder; Nicolas Reyns Journal: Neurosurg Rev Date: 2021-02-03 Impact factor: 3.042