Swinney Christian, Li Amy, Bhatti Inderpreet, Veeravagu Anand
Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
J Clin Neurosci. 2016 Dec;34:11-14. doi: 10.1016/j.jocn.2016.05.030. Epub 2016 Jul 25.
Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technology allows for the removal of residual tumor mass following initial tumor removal, maximizing the extent of resection. This, in turn, has been shown to lead to improved outcomes. Individual studies have examined the impact of ioMRI on the rate of extended resection, but a comprehensive review of this topic is needed. A literature review of the MEDLINE, EMBASE, CENTRAL, and Google Scholar databases revealed 12 eligible studies. This included 804 primary operations and 238 extended resections based on ioMRI findings. Use of ioMRI led to extended tumor resection in 13.3-54.8% of patients (mean 37.3%). Stratification by tumor type showed additional resection occurred, on average, in 39.1% of glioma resections (range 13.3-70.0%), 23.5% of pituitary tumor resections (range 13.3-33.7%), and 35.0% of nonspecific tumor resections (range 17.5-40%). Tumor type (glioma vs. pituitary) did not significantly influence the rate of further excision following ioMRI (p=0.309). There was no difference in secondary resection rate between studies limited to pediatric patients and those including adults (p=0.646). Thus, the use of intra-operative MRI frequently results in further resection of tumors. It is primarily used for the resection of gliomas and pituitary tumors. Tumor type does not appear to be a significant contributing factor to the rate of secondary tumor removal. Limited evidence suggests that extended resection may translate into improved clinical outcomes and mortality rates. However, results have not been unanimous, while clinical effect sizes have often been modest.
术中磁共振成像（ioMRI）可用于优化肿瘤切除。这项技术的应用能够在初次肿瘤切除后切除残留肿瘤灶，使切除范围最大化。反过来，这已被证明能带来更好的治疗效果。个别研究已探讨了ioMRI对扩大切除率的影响，但仍需要对该主题进行全面综述。对MEDLINE、EMBASE、CENTRAL和谷歌学术数据库的文献综述显示有12项符合条件的研究。这包括基于ioMRI结果的804例初次手术和238例扩大切除术。使用ioMRI使13.3%至54.8%的患者实现了扩大肿瘤切除（平均为37.3%）。按肿瘤类型分层显示，平均而言，39.1%的胶质瘤切除术（范围为13.3%至70.0%）、23.5%的垂体瘤切除术（范围为13.3%至33.7%）以及35.0%的非特异性肿瘤切除术（范围为17.5%至40%）进行了额外切除。肿瘤类型（胶质瘤与垂体瘤）对ioMRI后进一步切除率没有显著影响（p = 0.309）。限于儿科患者的研究与包括成人的研究之间，二次切除率没有差异（p = 0.646）。因此，术中磁共振成像的使用经常会导致肿瘤的进一步切除。它主要用于胶质瘤和垂体瘤的切除。肿瘤类型似乎不是二次肿瘤切除率的重要影响因素。有限证据表明扩大切除可能转化为更好的临床疗效和死亡率。然而，结果并不一致，而临床效应大小往往较小。
