Clinical experience of 3T intraoperative magnetic resonance imaging integrated neurosurgical suite in Shanghai Huashan Hospital

Background Intraoperative magnetic resonance imaging （iMRI） dates back to the 1990s and has been successfully applied in neurosurgery but they were low-field iMRI （〈1.0T）. This paper reports the clinical experience with a 3T iMRI-integrated neurosurgical suite in Huashan Hospital, Shanghai, China. Methods From September 2010 through March 2012, 373 consecutive patients underwent neurological surgery under guidance with 3T iMRI. A retrospective analysis was conducted regarding clinical efficiency. Results All surgery in the 373 patients was safe. The ratio of gross total resection for cerebral gliomas （n=161） was increased from 55.90% to 87.58%. The ratio of benefit in extent of resection was 39.13%. One hundred and fifty eight of the 161 glioma patients accomplished follow-up at 3 months postoperatively. Twenty of 161 patients （12.42%） suffered from early motor deficit after surgery. Late motor deficit was however observed in five of 158 patients （3.16%）. Twenty-one of 161 patients （13.04%） had early speech deficit and late speech deficit was only observed in six of 158 patients （3.80%）. The ratio of gross total resection for pituitary adenomas （n=49） was increased from 77.55% to 85.71%. The ratio of benefit in extent of resection was 10.2%. There were no iMRI-related adverse events even for patients who underwent awake craniotomy. Conclusion The 3T iMRI integrated neurosurgical suite provides high-quality intraoperative structural and functional imaging for real-time tumor resection control and accurate functional preservation, resulting in an improvement in maximal safe brain surgery.

Intraoperative high-field magnetic resonance imaging, multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas

Objective: To determine the beneficial effects of intraoperative high-field magnetic resonance imaging (MRI), multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas. Methods: Twelve patients with 13 supratentorial cavernomas were prospectively enrolled and operated while using a 1.5 T intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. All cavernomas were deeply located in subcortical areas or involved critical areas. Intraoperative high-field MRIs were obtained for the intraoperative“visu-alization”of surrounding eloquent structures,“brain shift”corrections, and navigational plan updates. Results: All cavernomas were successfully resected with guidance from intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. In 5 cases with supratentorial cavernomas, intraoperative “brain shift” severely deterred locating of the lesions;however, intraoperative MRI facilitated precise locating of these lesions. During long-term (>3 months) follow-up, some or all presenting signs and symptoms improved or resolved in 4 cases, but were unchanged in 7 patients. Conclusions: Intraoperative high-field MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring are helpful in surgeries for the treatment of small deeply seated subcortical cavernomas.

Identification of risk factors for poor language outcome in surgical resection of glioma involving the arcuate fasciculus:an observational study

The arcuate fasciculus is a critical component of the neural substrate of human language function.Surgical resection of glioma adjacent to the arcuate fasciculus likely damages this region.In this study,we evaluated the outcome of surgical resection of glioma adjacent to the arcuate fasciculus under the guidance of magnetic resonance imaging and diffusion tensor imaging,and we aimed to identify the risk factors for postoperative linguistic deficit.In total,54 patients with primary glioma adjacent to the arcuate fasciculus were included in this observational study.These patients comprised 38 men and 16 women(aged 43±11 years).All patients underwent surgical resenction of glioma under the guidance of magnetic resonance imaging and diffusion tensor imaging.Intraoperative images were updated when necessary for further resection.The gross total resection rate of the 54 patients increased from 38.9%to 70.4%by intraoperative magnetic resonance imaging.Preoperative language function and glioma-to-arcuate fasciculus distance were associated with poor language outcome.Multivariable logistic regression analyses showed that glioma-to-arcuate fasciculus distance was the major independent risk factor for poor outcome.The cutoff point of glioma-to-arcuate fasciculus distance for poor outcome was 3.2 mm.These findings suggest that intraoperative magnetic resonance imaging combined with diffusion tensor imaging of the arcuate fasciculus can help optimize tumor resection and result in the least damage to the arcuate fasciculus.Notably,glioma-to-arcuate fasciculus distance is a key independent risk factor for poor postoperative language outcome.This study was approved by the Ethics Committee of the Chinese PLA General Hospital,China(approval No.S2014-096-01)on October 11,2014.