NI-86COMBINED AWAKE BRAIN MAPPING AND LOW-FIELD INTRAOPERATIVE MRI FOR BRAIN TUMOR RESECTION

• Published in: Neuro-oncology (Charlottesville, Va.) Va.), 2014-11, Vol.16 (Suppl 5), p.v157-v158
• Main Authors: Zavarella, Salvatore M., Gandhi, Shashank V., Nardi, Dominic, Schaffer, Sarah, Schulder, Michael
• Format: Article
• Language: English
• Subjects: Abstracts
• ISSN: 1522-8517; 1523-5866
• DOI: 10.1093/neuonc/nou264.84

BACKGROUND: Surgery for patients with intraparenchymal brain tumors is often reported as being done with intraoperative MRI guidance or with awake mapping, but rarely with these two methods in tandem. We report our experience performing awake image-guided surgery using a compact iMRI. METHODS: Surgery in 25 patients was done using the PoleStar iMRI system (Medtronic Surgical Technologies). All patients had a glioma in the dominant hemisphere for language. Patients were divided into 4 groups depending on how mapping and imaging effected surgery: Group A: gross total resection (GTR) without imaging; Group B: GTR with the aid of iMRI; Group C: language mapping stopped surgery before further imaging; Group D: language mapping stopped surgery after iMRI revealed residual tumor. RESULTS: The number of iMRI scans acquired ranged from 1 to 5 (mean 2.6), adding an average of 1.4 hours to surgery. There were 7/25 patients in Group A, 6/25 in Group B, 3/25 in Group C, and 9/25 in Group D. Overall, intraoperative imaging led to further resection in 15/25 patients, while language mapping stopped surgery in 12/25. Gross total resection was achieved in 13 patients. A mean follow up of 16.9 months revealed no major new postoperative deficits. Minor deficits of language, calculation, contralateral weakness occurred in 12/25 patients, while language function worsened in 3 patients (12%). CONCLUSIONS: Neurosurgeons should not have to choose between these two modalities, removing the guesswork out of intracranial tumor surgery. Compact iMRI is easily integrated with awake surgery and cortical mapping to ensure accurate resection of gliomas in the dominant hemisphere, while preserving neurological function. In only a small minority of patients with such tumors can a GTR be safely achieved without the use of iMRI and/or language mapping.