Combination of Intraoperative Magnetic Resonance Imaging... : Neurosurgery (original) (raw)

RESEARCH—HUMAN—CLINICAL STUDIES

Combination of Intraoperative Magnetic Resonance Imaging and Intraoperative Fluorescence to Enhance the Resection of Contrast Enhancing Gliomas

Gessler, Florian MD*; Forster, Marie-Thérèse MD*; Duetzmann, Stephan MD*; Mittelbronn, Michel MD‡; Hattingen, Elke MD, PhD§; Franz, Kea MD*; Seifert, Volker MD, PhD*; Senft, Christian MD, PhD*

*Department of Neurosurgery, Goethe-University, Frankfurt, Germany;

‡Institute of Neurology (Edinger-Institute), Goethe-University, Frankfurt, Germany;

§Institute of Neuroradiology, Goethe-University, Frankfurt, Germany

Correspondence: Florian Gessler, MD, Department of Neurosurgery, Goethe-University, Schleusenweg 2-16, 60528 Frankfurt, Germany. E-mail: [email protected]

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.neurosurgery-online.com).

Received November 03, 2014

Accepted February 03, 2015

Abstract

BACKGROUND:

Evidence suggests that extent of resection (EOR) is a prognostic factor for patients harboring gliomas. Recent studies have displayed the importance of intraoperative magnetic resonance imaging (iMRI) with 5-aminolevulinic acid (5-ALA) fluorescence-guidance in order to maximize EOR.

OBJECTIVE:

To compare iMRI and 5-ALA fluorescence-guidance and the impact on patient survival.

METHODS:

Thirty-two patients with contrast-enhancing gliomas undergoing intended gross total resection (GTR) were included in a prospective study. Surgeries were started under white-light conditions. When GTR was thought to be achieved, an iMRI scan was performed and a blue light turned on to search for unintentionally remaining tumor tissue. iMRI findings were compared with intraoperative fluorescence findings. Histological examination of tumor bulk and any additionally resected tissue was performed. All patients underwent early postoperative high-field MRI to determine EOR.

RESULTS:

In 13 patients (40.6%), iMRI and fluorescence unequivocally did not show residual tumor intraoperatively. In 19 patients (59.4%), resection was continued due to iMRI or fluorescence findings. In 9 of these (47.4%), iMRI and fluorescence findings were inconsistent regarding residual tumor. GTR according to postoperative MRI was achieved in all but 1 patient. Histological examination ruled out false positive findings in all additionally resected specimens. Sensitivity and specificity to detect residual tumor tissue were 75% and 100%, respectively, for iMRI and 70% and 100% for 5-ALA fluorescence.

CONCLUSION:

Use of iMRI as well as fluorescence-guidance are appropriate methods to improve the extent of resection in surgery of contrast-enhancing gliomas. Best results can be achieved by complementary use of both modalities.

ABBREVIATIONS:

5-ALA, 5-aminolevulinic acid

EOR, extent of resection

iMRI, intraoperative magnetic resonance imaging