Impact of Intraoperative Magnetic Resonance Imaging (i-MRI) on Surgeon Decision Making and Clinical Outcomes in Cranial Tumor Surgery

Krishnapundha Bunyaratavej; Rungsak Siwanuwatn; Lawan Tuchinda; Piyanat Wangsawatwong

doi:10.1055/s-0042-1751008

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(02): 218-226
DOI: 10.1055/s-0042-1751008

Original Article

Impact of Intraoperative Magnetic Resonance Imaging (i-MRI) on Surgeon Decision Making and Clinical Outcomes in Cranial Tumor Surgery

Krishnapundha Bunyaratavej

¹Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Pathumwan, Bangkok, Thailand

,

Rungsak Siwanuwatn

¹Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Pathumwan, Bangkok, Thailand

,

Lawan Tuchinda

²Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Pathumwan, Bangkok, Thailand

,

Piyanat Wangsawatwong

¹Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Pathumwan, Bangkok, Thailand

› Institutsangaben

Abstract

Background Although intraoperative magnetic resonance imaging (iMRI) has an established role in guiding intraoperative extent of resection (EOR) in cranial tumor surgery, the details of how iMRI data are used by the surgeon in the real-time decision-making process is lacking.

Materials and Methods The authors retrospectively reviewed 40 consecutive patients who underwent cranial tumor resection with the guidance of iMRI. The tumor volumes were measured by volumetric software. Intraoperative and postoperative EOR were calculated and compared. Surgeon preoperative EOR intention, intraoperative EOR assessment, and how iMRI data impacted surgeon decisions were analyzed.

Results The pathology consisted of 29 gliomas, 8 pituitary tumors, and 3 other tumors. Preoperative surgeon intention called for gross total resection (GTR) in 28 (70%) cases. After resection and before iMRI scanning, GTR was 20 (50.0%) cases based on the surgeon's perception. After iMRI scanning, the results helped identify 19 (47.5%) cases with unexpected results consisting of 5 (12.5%) with unexpected locations of residual tumors and 14 (35%) with unexpected EOR. Additional resection was performed in 24 (60%) cases after iMRI review, including 6 (15%) cases with expected iMRI results. Among 34 cases with postoperative MRI results, iMRI helped improve EOR in 12 (35.3%) cases.

Conclusion In cranial tumor surgery, the surgeon's preoperative and intraoperative assessment is frequently imprecise. iMRI data serve several purposes, including identifying the presence of residual tumors, providing residual tumor locations, giving spatial relation data of the tumor with nearby eloquent structures, and updating the neuro-navigation system for the final stage of tumor resection.

Keywords

cranial tumor - extent of resection - glioma - gross total resection - intraoperative MRI

Volltext

Referenzen

References
1 Black PM, Alexander III E, Martin C. et al. Craniotomy for tumor treatment in an intraoperative magnetic resonance imaging unit. Neurosurgery 1999; 45 (03) 423-431 , discussion 431–433
2 Bisdas S, Roder C, Ernemann U, Tatagiba MS. Intraoperative MR iaging in neurosurgery. Clin Neuroradiol 2015; 25 (Suppl. 02) 237-244
3 Coburger J, Merkel A, Scherer M. et al. Low-grade glioma surgery in intraoperative magnetic resonance imaging: results of a multicenter retrospective assessment of the German Study Group for Intraoperative Magnetic Resonance Imaging. Neurosurgery 2016; 78 (06) 775-786
4 Fountain DM, Bryant A, Barone DG. et al. Intraoperative imaging technology to maximise extent of resection for glioma: a network meta-analysis. Cochrane Database Syst Rev 2021; 1: CD013630
5 Kubben PL, ter Meulen KJ, Schijns OE, ter Laak-Poort MP, van Overbeeke JJ, van Santbrink H. Intraoperative MRI-guided resection of glioblastoma multiforme: a systematic review. Lancet Oncol 2011; 12 (11) 1062-1070
6 Rao G. Intraoperative MRI and maximizing extent of resection. Neurosurg Clin N Am 2017; 28 (04) 477-485
7 Senft C, Bink A, Franz K, Vatter H, Gasser T, Seifert V. Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 2011; 12 (11) 997-1003
8 Hatiboglu MA, Weinberg JS, Suki D. et al. Impact of intraoperative high-field magnetic resonance imaging guidance on glioma surgery: a prospective volumetric analysis. Neurosurgery 2009; 64 (06) 1073-1081 , discussion 1081
9 Kuhnt D, Ganslandt O, Schlaffer SM, Buchfelder M, Nimsky C. Quantification of glioma removal by intraoperative high-field magnetic resonance imaging: an update. Neurosurgery 2011; 69 (04) 852-862 , discussion 862–863
10 Lewin JS, Nour SG, Meyers ML. et al. Intraoperative MRI with a rotating, tiltable surgical table: a time use study and clinical results in 122 patients. Am J Roentgenol 2007; 189 (05) 1096-1103
11 Nimsky C, Fujita A, Ganslandt O, Von Keller B, Fahlbusch R. Volumetric assessment of glioma removal by intraoperative high-field magnetic resonance imaging. Neurosurgery 2004; 55 (02) 358-370 , discussion 370–371
12 Olubiyi OI, Ozdemir A, Incekara F. et al. Intraoperative magnetic resonance imaging in intracranial glioma resection: a single-center, retrospective blinded volumetric study. World Neurosurg 2015; 84 (02) 528-536
13 Mohammadi AM, Sullivan TB, Barnett GH. et al. Use of high-field intraoperative magnetic resonance imaging to enhance the extent of resection of enhancing and nonenhancing gliomas. Neurosurgery 2014; 74 (04) 339-348 , discussion 349, quiz 349–350
14 Alhilali LM, Little AS, Yuen KCJ. et al. Early postoperative MRI and detection of residual adenoma after transsphenoidal pituitary surgery. J Neurosurg 2020; 134 (03) 761-770
15 Pala A, Durner G, Braun M, Schmitz B, Wirtz CR, Coburger J. The impact of an ultra-early postoperative MRI on treatment of lower grade glioma. Cancers (Basel) 2021; 13 (12) 13
16 Fahlbusch R, Keller Bv, Ganslandt O, Kreutzer J, Nimsky C. Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging. Eur J Endocrinol 2005; 153 (02) 239-248
17 Hlaváč M, Knoll A, Mayer B. et al. Ten years' experience with intraoperative MRI-assisted transsphenoidal pituitary surgery. Neurosurg Focus 2020; 48 (06) E14
18 Ginat DT, Swearingen B, Curry W, Cahill D, Madsen J, Schaefer PW. 3 Tesla intraoperative MRI for brain tumor surgery. J Magn Reson Imaging 2014; 39 (06) 1357-1365
19 Giordano M, Samii A, Lawson McLean AC. et al. Intraoperative magnetic resonance imaging in pediatric neurosurgery: safety and utility. J Neurosurg Pediatr 2017; 19 (01) 77-84
20 Rogers CM, Jones PS, Weinberg JS. Intraoperative MRI for brain tumors. J Neurooncol 2021; 151 (03) 479-490
21 Schulder M, Carmel PW. Intraoperative magnetic resonance imaging: impact on brain tumor surgery. Cancer Contr 2003; 10 (02) 115-124
22 Scherer M, Jungk C, Younsi A, Kickingereder P, Müller S, Unterberg A. Factors triggering an additional resection and determining residual tumor volume on intraoperative MRI: analysis from a prospective single-center registry of supratentorial gliomas. Neurosurg Focus 2016; 40 (03) E4
23 Lau D, Hervey-Jumper SL, Han SJ, Berger MS. Intraoperative perception and estimates on extent of resection during awake glioma surgery: overcoming the learning curve. J Neurosurg 2018; 128 (05) 1410-1418
24 Leroy HA, Delmaire C, Le Rhun E, Drumez E, Lejeune JP, Reyns N. High-field intraoperative MRI in glioma surgery: a prospective study with volumetric analysis of extent of resection and functional outcome. Neurochirurgie 2018; 64 (03) 155-160
25 Juthani RG, Reiner AS, Patel AR. et al. Radiographic and clinical outcomes using intraoperative magnetic resonance imaging for transsphenoidal resection of pituitary adenomas. J Neurosurg 2020; 134 (06) 1824-1835
26 Zaidi HA, De Los Reyes K, Barkhoudarian G. et al. The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the advanced multimodality image guided operating suite. Neurosurg Focus 2016; 40 (03) E18
27 Edjlali M, Ploton L, Maurage CA. et al. Intraoperative MRI and FLAIR analysis: implications for low-grade glioma surgery. J Neuroradiol 2021; 48 (01) 61-64
28 Hirschl RA, Wilson J, Miller B, Bergese S, Chiocca E. The predictive value of low-field strength magnetic resonance imaging for intraoperative residual tumor detection. Clinical article. J Neurosurg 2009; 111 (02) 252-257
29 Knauth M, Aras N, Wirtz CR, Dörfler A, Engelhorn T, Sartor K. Surgically induced intracranial contrast enhancement: potential source of diagnostic error in intraoperative MR imaging. Am J Neuroradiol 1999; 20 (08) 1547-1553
30 Koo TK, Li MY. A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med 2016; 15 (02) 155-163
31 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (01) 159-174
32 Fomekong E, Duprez T, Docquier MA, Ntsambi G, Maiter D, Raftopoulos C. Intraoperative 3T MRI for pituitary macroadenoma resection: Initial experience in 73 consecutive patients. Clin Neurol Neurosurg 2014; 126: 143-149
33 Hannan CJ, Daousi C, Radon M, Gilkes CE. 3 Tesla intra-operative MRI as an adjunct to endoscopic pituitary surgery: an early assessment of clinical utility. Br J Neurosurg 2021;
34 Jankovski A, Francotte F, Vaz G. et al. Intraoperative magnetic resonance imaging at 3-T using a dual independent operating room-magnetic resonance imaging suite: development, feasibility, safety, and preliminary experience. Neurosurgery 2008; 63 (03) 412-424 , discussion 424–426
35 Patel KS, Yao Y, Wang R, Carter BS, Chen CC. Intraoperative magnetic resonance imaging assessment of non-functioning pituitary adenomas during transsphenoidal surgery. Pituitary 2016; 19 (02) 222-231
36 Bunyaratavej K, Sangtongjaraskul S, Lerdsirisopon S, Tuchinda L. Continuous physical examination during subcortical resection in awake craniotomy patients: its usefulness and surgical outcome. Clin Neurol Neurosurg 2016; 147: 34-38
37 Bunyaratavej K, Wangsawatwong P. Catheter guided cerebral glioma resection combined with awake craniotomy: its usefulness and surgical outcome. Br J Neurosurg 2019; 33 (05) 528-535
38 Ahmadi R, Campos B, Haux D, Rieke J, Beigel B, Unterberg A. Assessing perioperative complications associated with use of intraoperative magnetic resonance imaging during glioma surgery - a single centre experience with 516 cases. Br J Neurosurg 2016; 30 (04) 397-400
39 Lu CY, Chen XL, Chen XL, Fang XJ, Zhao YL. Clinical application of 3.0 T intraoperative magnetic resonance combined with multimodal neuronavigation in resection of cerebral eloquent area glioma. Medicine (Baltimore) 2018; 97 (34) e11702
40 Eljamel MS, Mahboob SO. The effectiveness and cost-effectiveness of intraoperative imaging in high-grade glioma resection; a comparative review of intraoperative ALA, fluorescein, ultrasound and MRI. Photodiagn Photodyn Ther 2016; 16: 35-43