Resection of gliomas by intraoperative high⁃field MRI combined with fluorescence⁃ guided

Objective To investigate the efficacy and safety of intraoperative high⁃field MRI combined with fluorescence⁃guided glioma resection. Methods A total of 53 patients with glioma admitted to The Fisrt Bethune Hospital of Jilin University from June 2017 to June 2018 were enrolled, including 33 patients (62.26%) whose tumors were located in important brain functional areas (17 cases in motor area, 11 cases in language area, 5 cases in thalamus). Glioma resection was performed under fluorescence⁃guided (fluorescence guidance group, n=28) and intraoperative high⁃field MRI combined with fluorescence⁃guided glioma resection (combined group, n=25). Results Total tumor resection was performed in 42 cases (79.25%) and subtotal tumor resection in 11 cases (20.75%). Of the 33 patients whose tumors were located in important brain functional areas, total resection was performed in 25 cases (75.76%) and subtotal resection in 8 cases (24.24%). There were 12 cases (22.64%) of astrocytoma (WHO grade Ⅱ), 17 cases (32.08%) of anaplastic astrocytoma (WHO grade Ⅲ) and 24 cases (45.28%) of glioblastoma (WHO grade Ⅳ) were confirmed by postoperative pathology. There were 16 cases of speech disorder (30.19%), 21 cases of transient limb movement disorder (39.62%), 6 cases of mental disorder (11.32%), 8 cases of intracranial infection (15.09%), 2 cases of small epidural hemorrhage (3.77%), and no death after the operation. The operation time of combined group was longer than that of fluorescence guidance group [(3.79±1.14) h vs. (2.53±1.04) h; t=⁃4.718, P=0.000]. The tumor total resection rate in the combined group was higher than that in fluorescent guidance group [92% (23/25) vs. 67.86% (19/28); χ2=4.681, P=0.031], the WHO grade had significant difference between 2 groups (χ2=2.041, P=0.036), but the tumor total resection rate in important brain functional areas [88.89% (16/18) vs. 60% (9/15); Fisher's exact probability: P=0.101] and the incidence of postoperative complications [37.73% (20/53) vs. 62.26% (33/53); χ2=0.179, P=1.000] were no significant difference between 2 groups. In the mean follow⁃up of 9 months, 11 patients (20.75%) had tumor recurrence. There was no significant difference in the recurrence rate between combined group and fluorescence guidance group [12% (3/25) vs. 28.57% (8/28); χ2=2.205, P=0.138]. Conclusions Intraoperative high⁃field MRI combined with fluorescence guidance can significantly improve the total resection rate of glioma, while preserving important brain functional areas and neural structures as much as possible, improving the quality of life and prolonging the progression⁃free survival of patients.