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The value of intraoperative MRI in recurrent intracranial tumor surgery
Journal article

The value of intraoperative MRI in recurrent intracranial tumor surgery

  • Wang, Sophie S. 2Institute of Intensive Care Medicine, University Hospital Zurich;
  • Selge, Friederike 2Institute of Intensive Care Medicine, University Hospital Zurich;
  • Sebök, Martina 3Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich;
  • Scheffler, Pierre 3Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich;
  • Yang, Yang 5Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Switzerland
  • Brandi, Giovanna 2Institute of Intensive Care Medicine, University Hospital Zurich;
  • Winklhofer, Sebastian 4Department of Neuroradiology, University Hospital Zurich, Clinical Neuroscience Center, Zurich; and
  • Bozinov, Oliver 5Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Switzerland
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Published in:
  • Journal of Neurosurgery. - Journal of Neurosurgery Publishing Group (JNSPG). - 2020, p. 1-8
Surgery
Clinical Neurology
English OBJECTIVEIdentifying tumor remnants in previously operated tumor lesions remains a challenge. Intraoperative MRI (ioMRI) helps the neurosurgeon to reorient and update image guidance during surgery. The purpose of this study was to analyze whether ioMRI is more efficient in detecting tumor remnants in the surgery of recurrent lesions compared with primary surgery.METHODSAll consecutive patients undergoing elective intracranial tumor surgery between 2013 and 2018 at the authors’ institution were included in this retrospective cohort study. The cohort was divided into two groups: re-craniotomy and primary craniotomy. In contrast-enhancing tumors, tumor suspicion in ioMRI was defined as contrast enhancement in T1-weighted imaging. In non–contrast-enhancing tumors, tumor suspicion was defined as hypointensity in T1-weighted imaging and hyperintensity in T2-weighted imaging and FLAIR. In cases in which the ioMRI tumor suspicion was a false positive and not confirmed during in situ inspection by the neurosurgeon, the signal was defined as a tumor-imitating ioMRI signal (TIM). Descriptive statistics were performed.RESULTSA total of 214 tumor surgeries met the inclusion criteria. The re-craniotomy group included 89 surgeries, and the primary craniotomy group included 123 surgeries. Initial complete resection after ioMRI was less frequent in the re-craniotomy group than in the primary craniotomy group, but this was not a statistically significant difference. Radiological suspicion of tumor remnants in ioMRI was present in 78% of re-craniotomy surgeries and 69% of primary craniotomy surgeries. The incidence of false-positive TIMs was significantly higher in the re-craniotomy group (n = 11, 12%) compared with the primary craniotomy group (n = 5, 4%; p = 0.015), and in contrast-enhancing tumors was related to hemorrhages in situ (n = 9).CONCLUSIONSA history of previous surgery in contrast-enhancing tumors made correct identification of tumor remnants in ioMRI more difficult, with a higher rate of false-positive ioMRI signals in the re-craniotomy group. The majority of TIMs were associated with the inability to distinguish contrast enhancement from hyperacute hemorrhage. The addition of a specific sequence in ioMRI to further differentiate both should be investigated in future studies.
Language
  • English
Open access status
closed
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Persistent URL
https://sonar.ch/global/documents/93193
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