Abstract
For patients with gliomas, the goal of surgery is to maximize the extent of tumor resection while avoiding injury to functional tissue. The hope is to improve patients’ survival and maintain the highest quality of life as possible. However, because of the infiltrative nature of gliomas these two goals often oppose each other so a compromise must be met. Many tools have been developed to help with this challenge of glioma surgery. Over the past two decades, intraoperative-magnetic resonance imaging (iMRI) has emerged as an increasingly important modality to enhance surgical safety while providing the surgeon with updated information to guide their resection. Here the authors review the studies that demonstrate a positive correlation between extent of resection (EOR) and overall survival (OS), although the data is clearer in patients with low-grade gliomas (LGG) and still somewhat controversial in those with higher-grade tumors. We will then review some of the studies that support the role of iMRI and how it has impacted glioma surgery by increasing the EOR. The value of iMRI usage in regards to overall patient outcome can be extrapolated through its effect on EOR. Overall, available data support the safe use of iMRI and as an effective adjunct in glioma surgery.
Highlights
The surgical resection of gliomas has been a challenge since the beginning of modern neurosurgery
The question is does pushing the extent of resection (EOR) to its maximum, which may increase chances of new neurological deficits, have any long-term benefits? Can a gross total resection (GTR) change the natural history of the disease process? To answer these questions, we look at the literature on gliomas and consider low-grade gliomas (LGG) and high-grade gliomas (HGGs) separately because of their different natural histories
A maximal resection while avoiding neurological injury is the preferred surgical goal in these patients. intraoperative-magnetic resonance imaging (iMRI) has become an increasingly important tool in augmenting surgical judgment in order to help achieve the maximal EOR during tumor surgery
Summary
Received April 20, 2012; Accepted September 4, 2012. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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