Abstract
Abstract AIMS Maximal safe resection is the objective of most neuro-oncological operations. The extent of resection can be maximized using imaging updated intraoperatively, including intraoperative MRI (iMRI) theatre, which may translate to improved overall survival. This study aimed to present our 15-year iMRI theatre experience and review its utility. METHOD A retrospective cohort analysis was conducted to include all intracranial tumour operations performed in the iMRI theatre (2007–2022). Cases were classified according to their histopathology: low- and high-grade gliomas (LGG and HGG respectively), meningiomas, pituitary adenomas, and metastases. Demographic, clinical, and histological data was extracted from SurgiNet and analyzed by using the WHO 2021 classification. The impact of intraoperative MRI on operative outcomes was reviewed. RESULTS A total of 478 neuro-oncology cases were identified, consisting of 194 pituitary adenomas (n= 69 cases via microscope), 162 HGG, 108 LGG (n= 7 cases for biopsy), 10 cerebral metastases, and 4 meningiomas. Intraoperative MRI theatre utilization averaged 41 cases per year throughout our 15-year experience. The median age was 47 years old (range 35-59 yo.) with a slight predominance in the female population (n= 298, 52%). We identified 85 (17.8%) re-do cases, which include: pituitary adenoma (n= 15, 17.6%), glioma (n= 68, 80%), and intracranial metastasis (n= 2, 2.4%). Of the 10 intracranial metastases, melanoma consisted of 5, lung carcinoma of 3, and renal cell- and colorectal-carcinoma represented 1 case, respectively. Intraoperative MRI confirmed complete resection in all meningioma cases. CONCLUSION In this series, iMRI has been utilised mostly for pituitary adenoma resection and gliomas. It provides near realtime intraoperative navigation and imaging to maximise the extent of resection, prevent injury to important structures and improve patient outcomes in tumour resections.
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