Coburger Jan, Segovia von Riehm Javier, Ganslandt Oliver, Wirtz Christian Rainer, Renovanz Mirjam
Department of Neurosurgery, University of Ulm, Günzburg, Germany.
Department of Neurosurgery, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Germany.
World Neurosurg. 2018 Feb;110:e389-e397. doi: 10.1016/j.wneu.2017.11.015. Epub 2017 Nov 11.
Surgery in patients with highly eloquent glioblastoma (GB) remains challenging. The aim of this study was to evaluate influence of use of intraoperative magnetic resonance imaging (iMRI) on extent of resection (EOR), clinical outcome, and survival in patients with preoperatively intended subtotal resection of GB.
Retrospective assessment was performed in 3 neurosurgical centers (2008-2013). All patients with primary GB, unilocular growth, and adjuvant radiochemotherapy in whom subtotal resection was intended were included. Imaging data were pseudonymized and volumetrically assessed by a central reviewer. Clinical outcome was evaluated based on complications, new permanent neurologic deficits, and survival. Based on subtraction of potential EOR (as defined by reviewer) from effective EOR, EOR change (ΔEOR) was calculated for each case. We calculated multivariate linear regressions to assess influence on effective EOR and ΔEOR, binary regressions to assess influence on complications and new permanent neurologic deficits, and Cox regression models to assess survival.
Assessment included 70 patients. In iMRI group, a significantly lower ΔEOR (4% vs. 22%, P = 0.008) was found. In linear regression model controlling for age, tumor volume, neurophysiologic mapping, and iMRI, only iMRI influenced ΔEOR significantly (P = 0.03, odds ratio 0.27). In binary regression model controlling for age, tumor volume, effective EOR, neurophysiologic mapping, and iMRI, none of the variables showed a significant difference concerning complications and new permanent neurologic deficits. Overall survival was significantly influenced by age (P = 0.03, odds ratio 1.02) and iMRI (P = 0.026, odds ratio 0.51).
Maximum safe resection is an important prognostic factor for patients with eloquent GBs. iMRI seems to be a relevant tool to achieve this goal.
对具有高功能区的胶质母细胞瘤（GB）患者进行手术仍然具有挑战性。本研究的目的是评估术中磁共振成像（iMRI）的使用对术前计划次全切除GB患者的切除范围（EOR）、临床结局和生存的影响。
在3个神经外科中心进行回顾性评估（2008 - 2013年）。纳入所有原发性GB、单房生长且计划进行辅助放化疗的次全切除患者。影像数据进行了匿名化处理，并由一名中心审阅者进行体积评估。基于并发症、新的永久性神经功能缺损和生存情况评估临床结局。根据审阅者定义的潜在EOR与有效EOR相减，计算每个病例的EOR变化（ΔEOR）。我们进行多变量线性回归以评估对有效EOR和ΔEOR的影响，二元回归以评估对并发症和新的永久性神经功能缺损的影响，以及Cox回归模型以评估生存情况。
评估包括70例患者。在iMRI组中，发现ΔEOR显著更低（4%对22%，P = 0.008）。在控制年龄、肿瘤体积、神经生理图谱和iMRI的线性回归模型中，只有iMRI对ΔEOR有显著影响（P = 0.03，优势比0.27）。在控制年龄、肿瘤体积、有效EOR、神经生理图谱和iMRI的二元回归模型中，没有变量在并发症和新的永久性神经功能缺损方面显示出显著差异。总生存受到年龄（P = 0.03，优势比1.02）和iMRI（P = 0.026，优势比0.51）的显著影响。
最大安全切除是具有高功能区GB患者的一个重要预后因素。iMRI似乎是实现这一目标的一个相关工具。
