Abstract
Objective: The radicality of tumour removal in patients suffering from glioma is discussed to
be an important factor for longer survival times. Therefore intraoperative imaging
modalities like magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound
(US) are tested in many neurosurgical facilities for clinical use. In our department
a mobile CT for intraoperative applications is used for this purpose since 1999. The
handling and useful application of the mobile CT scanner as well as results without
intraoperative imaging are discussed.
Material and Methods: 470 CT scans with the mobile CT were accomplished, including 270 cases of neuronavigation
planning, 76 cases of intraoperative scans, 48 cases of postoperative scans, 69 CT
scans for stereotactic biopsy planning and control as well as 3 cases of emergency
scanning in trauma patients and 4 spine applications. The results of the intraoperative
CT scans are compared with those of the postoperative MRI scans. Additionally 87 patients
with glioma were evaluated. These patients underwent surgery without intraoperative
imaging.
Results: In 27 out of 43 patients with glioma residual tumour was detected with intraoperative
CT. In 13 cases the surgery was resumed to complete resection, in 14 cases the operation
was not continued due to close vicinity to eloquent areas or difficulties in image
interpretation. In 44 cases the results of intraoperative CT and postoperative MRI
were compared. In 6 cases the MRI demonstrated residual tumour in contrast to the
results of the CT scans. In 3 cases the tumour removal could have been more complete
(6.8 %). In 87 cases glioma surgery was performed without intraoperative CT. In 6
cases a more complete tumour removal could have been performed (6.9 %) according to
the results of postoperative MRI.
Conclusion: Intraoperative imaging with a mobile CT scanner is a good method for detection of
residual tumour. The CT scanner can be integrated in an operative setting without
problems. Although intraoperative imaging can be helpful in some selected cases, most
of the neurosurgical procedures can be well performed with proper neuronavigation
planning.
Key words
Glioma - intraoperative imaging - mobile computed tomography
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Dr. med. H. Gumprecht
Städt. Krankenhaus München-Bogenhausen
Englschalkingerstrasse 77
81925 München
Germany
Phone: +49-89-9270-2564
Fax: +49-89-9270-2619
Email: h.gumprecht@kh-bogenhausen.de