Abd-El-Barr Muhammad M, Santos Seth M, Aglio Linda S, Young Geoffrey S, Mukundan Srinivasan, Golby Alexandra J, Gormley William B, Dunn Ian F
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Anesthesiology, Perioperative and Pain Management, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurg. 2015 Jun;83(6):921-8. doi: 10.1016/j.wneu.2015.02.002. Epub 2015 Feb 17.
There is accumulating evidence that extent of resection (EOR) in intrinsic brain tumor surgery prolongs overall survival (OS) and progression-free survival (PFS). One of the strategies to increase EOR is the use of intraoperative MRI (ioMRI); however, considerable infrastructure investment is needed to establish and maintain a sophisticated ioMRI. We report the preliminary results of an extraoperative (eoMRI) protocol, with a focus on safety, feasibility, and EOR in intrinsic brain tumor surgery.
Ten patients underwent an eoMRI protocol consisting of surgical resection in a conventional operating room followed by an immediate MRI in a clinical MRI scanner while the patient was still under anesthesia. If findings of the MRI suggested residual safely resectable tumor, the patient was returned to the operating room. A retrospective volumetric analysis was undertaken to investigate the percentage of tumor resected after first resection and if applicable, after further resection.
Six of 10 (60%) patients were thought to require no further resection after eoMRI. The EOR in these patients was 97.8% ± 1.8%. In the 4 patients who underwent further resection, the EOR during the original surgery was 88.5% ± 9.5% (P = 0.04). There was an average of 10.1% more tumor removed between the first and second surgery. In 3 of 4 (75%) of patients who returned for further resection, gross total resection of tumor was achieved.
An eoMRI protocol appears to be a safe and practical method to ensure maximum safe resections in patients with brain tumors and can be performed readily in all centers with MRI capabilities.
越来越多的证据表明，脑内肿瘤手术中的切除范围（EOR）可延长总生存期（OS）和无进展生存期（PFS）。增加EOR的策略之一是使用术中磁共振成像（ioMRI）；然而，建立和维护一套精密的ioMRI需要大量的基础设施投资。我们报告了一项手术室外（eoMRI）方案的初步结果，重点关注脑内肿瘤手术的安全性、可行性和EOR。
10例患者接受了eoMRI方案，包括在传统手术室进行手术切除，然后在患者仍处于麻醉状态时，在临床MRI扫描仪中立即进行MRI检查。如果MRI检查结果提示有残留的可安全切除的肿瘤，则患者返回手术室。进行回顾性容积分析，以研究首次切除后以及（如适用）进一步切除后切除的肿瘤百分比。
10例患者中有6例（60%）在eoMRI后被认为无需进一步切除。这些患者的EOR为97.8%±1.8%。在4例接受进一步切除的患者中，初次手术时的EOR为88.5%±9.5%（P = 0.04）。第一次和第二次手术之间平均多切除了10.1%的肿瘤。在4例返回进行进一步切除的患者中，有3例（75%）实现了肿瘤的全切除。
eoMRI方案似乎是一种安全实用的方法，可确保脑肿瘤患者实现最大安全切除，并且在所有具备MRI能力的中心都可以轻松实施。
