Abstract
Intraoperative MRI (ioMRI) has become a frequently used tool to improve maximum safe resection in brain tumor surgery. The usability of intraoperatively acquired diffusion-weighted imaging sequences to predict the extent and clinical relevance of new infarcts has not yet been studied. Furthermore, the question of whether more aggressive surgery after ioMRI leads to more or larger infarcts is of crucial interest for the surgeons’ operative strategy. Retrospective single-center analysis of a prospective registry of procedures from 2013 to 2019 with ioMRI was used. Infarct volumes in ioMRI/poMRI, lesion localization, mRS, and NIHSS were analyzed for each case. A total of 177 individual operations (60% male, mean age 45.5 years old) met the inclusion criteria. In 61% of the procedures, additional resection was performed after ioMRI, which resulted in a significantly higher number of new ischemic lesions postoperatively (p < .001). The development of new or enlarged ischemic areas upon additional resection could also be shown volumetrically (mean volume in ioMRI 0.39 cm3 vs. poMRI 2.97 cm3; p < .001). Despite the surgically induced new infarcts, mRS and NIHSS did not worsen significantly in cases with additional resection. Additionally, new perilesional ischemia in eloquently located tumors was not associated with an impaired neurological outcome. Additional resection after ioMRI leads to new or enlarged ischemic areas. However, these new infarcts do not necessarily result in an impaired neurological outcome, even when in eloquent brain areas.
Highlights
Intraoperative MRI during cranial tumor surgery has become a supplementary standard of care in many neurosurgical institutions for a variety of neurosurgical procedures [4, 12, 22, 23]
Sixty percent of the cases were first operations, whereas the remaining cases involved a previous operation on the lesion (Table 1). This difference was not associated with a higher number of new infarcts on postoperative MRI (poMRI) (Pearson’s chi-squared test, p = .2, Table 1)
Relevance of anatomic lesion localization for clinical impact of new infarcts As new infarcts might only become clinically apparent if they are localized in certain brain areas, we identified the anatomical localization of the operated lesions and their lateralization (Table 1): Resections within the frontal lobe represented the main part of the patient population, followed by lesions involving the perirolandic region
Summary
Intraoperative MRI during cranial tumor surgery has become a supplementary standard of care in many neurosurgical institutions for a variety of neurosurgical procedures [4, 12, 22, 23]. The intraoperative images are of great value to provide. Despite the evident advantages of ioMRI, little is known about the influence of DWI sequences on surgical strategy and Neurosurg Rev (2021) 44:2219–2227 aggressiveness in terms of resection control and their implications for potential new postoperative deficits. The aim of this study was to characterize the presence and extent of new ischemic lesions in ioMRI. We were interested in the question of whether a continuation of resection after intraoperative resection control with MRI might lead to more or enlarged postoperative infarcts
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