Senft Christian, Franz Kea, Ulrich Christian T, Bink Andrea, Szelényi Andrea, Gasser Thomas, Seifert Volker
Department of Neurosurgery, Johann Wolfgang Goethe-University, Schleusenweg 2-16, 60528 Frankfurt, Germany.
Clin Neurol Neurosurg. 2010 Apr;112(3):237-43. doi: 10.1016/j.clineuro.2009.12.003. Epub 2009 Dec 24.
The aim of this article is to report on our experience in using a low field intraoperative MRI (iMRI) system in glioma surgery and to summarize the hitherto use and benefits of iMRI in glioma surgery.
Between July 2004 and May 2009, a total of 103 patients harboring gliomas underwent tumor resection with the use of a mobile low field iMRI in our institution. Surgeries were performed as standard micro-neurosurgical procedures using regular instrumentarium. All patients underwent early postoperative high field MRI to determine the extent of resection. Adjuvant treatment was conducted according to histopathological grading and standard of care.
All tumors could be reliably visualized on intraoperative imaging. Intraoperative imaging revealed residual tumor tissue in 51 patients (49.5%), leading to further tumor resection in 31 patients (30.1%). Extended resection did not translate into a higher rate of neurological deficits. When analyzing survival of patients with glioblastoma, patients undergoing complete tumor resection did significantly better than patients with residual tumor (50% survival rate at 57.8 weeks vs. 33.8 weeks, log rank test p=0.003), while younger age did not influence survival (p=0.12).
Low field iMRI is a helpful tool in modern neurosurgery and facilitates brain tumor resection to a maximum safe extent. Its use translates into a better prognosis for these patients with devastating tumors. Future studies covering the use of iMRI will need to be conducted in a prospective, randomized fashion to prove the true benefit of iMRI in glioma surgery.
本文旨在报告我们在神经胶质瘤手术中使用低场术中磁共振成像（iMRI）系统的经验，并总结iMRI在神经胶质瘤手术中的应用及益处。
2004年7月至2009年5月期间，我院共有103例患有神经胶质瘤的患者使用移动式低场iMRI进行了肿瘤切除手术。手术采用标准的显微神经外科手术方式，使用常规器械。所有患者术后早期均接受了高场MRI检查以确定切除范围。辅助治疗根据组织病理学分级和护理标准进行。
所有肿瘤在术中成像上均可可靠显示。术中成像显示51例患者（49.5%）存在残留肿瘤组织，其中31例患者（30.1%）因此进行了进一步的肿瘤切除。扩大切除并未导致更高的神经功能缺损发生率。在分析胶质母细胞瘤患者的生存率时，肿瘤完全切除的患者明显比有残留肿瘤的患者预后更好（57.8周时生存率为50%，而残留肿瘤患者为33.8周，对数秩检验p = 0.003），而年龄较小对生存率无影响（p = 0.12）。
低场iMRI是现代神经外科手术中的一种有用工具，有助于将脑肿瘤切除至最大安全范围。其应用可使这些患有严重肿瘤的患者获得更好的预后。未来需要以前瞻性、随机的方式开展关于iMRI应用的研究，以证明iMRI在神经胶质瘤手术中的真正益处。
