Madani Daniel, Fonseka R Dineth, Kim Sihyong Jake, Tang Patrick, Muralidharan Krishna, Chang Nicholas, Wong Johnny
Department of Neurosurgery, Royal Prince Alfred Hospital, Sydney 2050, Australia.
Brain Sci. 2025 Jan 5;15(1):45. doi: 10.3390/brainsci15010045.
Maximal safe resection is the objective of most neuro-oncological operations. Intraoperative magnetic resonance imaging (iMRI) may guide the surgeon to improve the extent of safe resection. There is limited evidence comparing the impact of iMRI on the rates of further resection between tumour types.
To investigate the impact of iMRI on the rate of further resection following visualisation of residual tumour.
A retrospective cohort study identified all intracranial tumour operations performed in the 1.5 T iMRI machine of a single centre (2007-2023). Patients were identified using SurgiNet and were grouped according to their histopathological diagnosis in accordance with the WHO 2021 classification. The primary outcome was the rate of reoperation due to iMRI visualisation of residual tumours.
A total of 574 cases were identified, including 152 low-grade gliomas (LGG), 108 high-grade gliomas (HGG), 194 pituitary neuroendocrine tumours (PitNETs), 15 metastases, and 6 meningiomas. Further resection following iMRI visualisation occurred in 45% of LGG cases, 47% of HGG cases, 29% of PitNET cases, and no meningioma or metastasis cases. Chi-square analysis showed that the rate of further resection after iMRI use across 2018-2023 was significantly higher than that across 2007-2012 (46% versus 33%, = 0.036).
Intraoperative MRI for guiding further resection was most useful in cases of LGG and HGG, possibly reflecting the difficulty of differentiating these tumour types from normal brain tissue. In addition, there was increased reliance on iMRI over time, which may represent our surgeons becoming accustomed to its use.
最大安全切除是大多数神经肿瘤手术的目标。术中磁共振成像（iMRI）可指导外科医生提高安全切除范围。比较iMRI对不同肿瘤类型进一步切除率影响的证据有限。
探讨iMRI对残余肿瘤可视化后进一步切除率的影响。
一项回顾性队列研究确定了在单个中心的1.5T iMRI机器上进行的所有颅内肿瘤手术（2007 - 2023年）。使用SurgiNet识别患者，并根据世界卫生组织2021年分类的组织病理学诊断进行分组。主要结局是因iMRI显示残余肿瘤而再次手术的发生率。
共识别出574例病例，包括152例低级别胶质瘤（LGG）、108例高级别胶质瘤（HGG）、194例垂体神经内分泌肿瘤（PitNET）、15例转移瘤和6例脑膜瘤。iMRI可视化后，45%的LGG病例、47%的HGG病例、29%的PitNET病例进行了进一步切除，脑膜瘤和转移瘤病例均未进行进一步切除。卡方分析显示，2018 - 2023年期间使用iMRI后进一步切除率显著高于2007 - 2012年期间（46%对33%，P = 0.036）。
术中MRI指导进一步切除在LGG和HGG病例中最有用，这可能反映了将这些肿瘤类型与正常脑组织区分开来的难度。此外，随着时间的推移，对iMRI的依赖增加，这可能表明我们的外科医生已习惯使用它。
