Turkish Neurosurgery
Optimizing the extent of resection and minimizing the morbidity in insular high-grade glioma surgery by high-field intraoperative MRI guidance
Chen Li-feng1, Yang Yang2, Ma Xiao-dong1, Yu Xin-guang1, Gui Qiu-ping3, Xu Bai-nan1, Zhou Ding-biao1
1The Chinese PLA General Hospital, Department of Neurosurgery, Beijing,
2The Chinese PLA General Hospital, Department of Geriatric Neurology, Beijing,
3The Chinese PLA General Hospital, Department of pathology, Beijing,
DOI: 10.5137/1019-5149.JTN.18346-16.1
Aim:The author evaluated the impact of high-field intraoperative MRI (iMRI) and functional neuronavigation on insular high-grade glioma(HGG) surgery.Material and Methods:Between 2010 and 2014, 51 insular HGG patients underwent operations guided by combined high-field iMRI and functional neuronavigation.22 insular HGG patients underwent conventional neuronavigation operations were assessed as the control group. Tumor volumetric scan analysis, Karnofsky performance score (KPS) and follow-up results were reviewed retrospectively. Results:Residualtumor of 37 patients was further resected in the iMRI assisted group.The median extent of resection(EOR) increased significantly from 79% (58%–100%) to [96%( 86%–100%),p<0.001]. The median EOR of iMRI assisted group [96% (86%–100%)] was significantly higher than that of conventional neuronavigation group [84% (69%–100%); p =0.031].Mean residual tumor volume of iMRI assisted group [0.6 (0.0-5.2) cm3] was significantly smaller than that of conventional neuronavigation group [3.8 (0.0-12.1) cm3; p =0 .003]. KPS within3 days after surgery reduced and KPS at 3 months after surgery improved for both groups. KPS of iMRI assisted group [90(70-100)] was significantly higher than that of control group [80(60-100); p =0 .021] at 3 months after surgery. The median progression-free survival (PFS) of iMRI assisted group [18(9-42) months] is better than that of control group [15(3-32); p =0 .010]. The median overall survival (OS) of iMRI assisted group [28(14-49)] is better than that of control group [18 (7-38); p =0 .035].Conclusion:Combined high-field iMRI and functionalneuronavigation optimize the extent of resection and minimize the morbidity in insular HGG surgery. Aggressive resection of insular HGG is predictive of improved OS and PFS.
Corresponding author : Ma Xiao-dong