Preliminary application of intraoperative magnetic resonance imaging combined with neuronavigation in glioma surgery

Objective To review preliminary experiences in glioma resection in an integrated operating room equipped with 1.5T intraoperative magnetic resonance imaging (iMRI) and neuronavigation. Methods Clinical data of 49 cases of gliomas located in deep brain or eloquent areas were retrospectively analyzed, focusing on the influence of iMRI and neuronavigation on the surgical strategy, the extent of resection and preservation outcomes of patients' neural function. Results iMRI scan were performed in each case for 1 to 3 times, averaging (1.57 ± 0.68) times. First iMRI of 49 cases revealed that 17 cases of gliomas were completely removed, and 32 cases had different residual tumors, indicating that iMRI frequently affected or modified the surgical strategy of glioma (32/49, 65.31%). Tumors in 9 cases were not completely removed because diffusion tensor imaging (DTI) navigation and intraoperative neurophysiological monitoring found that the lesions were close to the eloquent areas or deep anatomical structures. Twenty three patients with residual tumors underwent further resection guided by iMRI (23/49, 46.94% ). As a result, the complete resection rate of tumors increased from 34.69% (17/49) to 81.63% (40/49). Compared to preoperative situation, follow⁃up study 6 months after the operation found that neural function of 19 cases were improved, and another 30 cases were equal or close to preoperative level without any tumor progression. Conclusion The integration of 1.5T iMRI and neuronavigation helps to maximize the safe removal of the tumors and minimize dysfunction, increasing the accuracy and safety of glioma surgery. DOI：10.3969/j.issn.1672⁃6731.2012.06.008