A Preliminary Experience with Use of Intraoperative Magnetic Resonance Imaging in Thalamic Glioma Surgery: A Case Series of 38 Patients

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• 作者：Xuan Zheng¹ ; Xinghua Xu¹ ; Hui Zhang² ; Qun Wang¹ ; Xiaodong Ma¹ ; Xiaolei Chen¹ ; Guochen Sun¹ ; Jiashu Zhang¹ ; Jinli Jiang¹ ; Bainan Xu¹ ; Jun Zhang¹ ; ^{junzhang301@163.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Diffusion tensor imaging ; Functional MRI ; Intraoperative MRI ; Microsurgery ; Thalamic glioma
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：89
• 期：Complete
• 页码：434-441
• 全文大小：5248 K

文摘

Thalamic gliomas are rare tumors that constitute 1%–5% of all central nervous system tumors. Despite advanced techniques and equipment, surgical resection remains challenging because of the vital structures adjacent to the tumor. Intraoperative magnetic resonance imaging (MRI) might play an active role during brain tumor surgery because it compensates for brain shift or operation-induced hemorrhage, which are challenging issues for neurosurgeons.

Methods

We reviewed 38 patients treated surgically under intraoperative MRI guidance between January 2008 and July 2015 at our center. Preoperative, intraoperative, and postoperative MRI scans were reviewed. Preoperative and postoperative motor power, morbidity and mortality, resection rate, surgical approach, pathologic results, and patient demographics were also reviewed.

Results

Mean patient age was 37 years ± 18; 12 patients were included in the low-grade group, and 26 patients were included in the high-grade group. Under intraoperative MRI guidance, the gross total resection rate was increased from 16 (42.1%) to 26 (68.4%), and the near-total or subtotal resection rate was increased from 5 (13.2%) to 9 (23.7%). Hematoma formation was discovered in 3 patients on intraoperative MRI scan; each patient underwent a hemostatic operation immediately.

Conclusions

With improvements in neurosurgical techniques and equipment, surgical resection is considered feasible in patients with thalamic gliomas. Intraoperative MRI may be helpful in achieving the maximal resection rate with minimal surgical-related morbidity. However, because of severe disease progression, the overall prognosis is unfavorable.