Initial Experience Using Intraoperative Magnetic Resonance Imaging During a Trans-Sulcal Tubular Retractor Approach for the Resection of Deep-Seated Brain Tumors: A Case Series.

Autor:	Akbari SHA; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri., Sylvester PT; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri., Kulwin C; Department of Neurological Surgery, Indiana University-Purdue University, Indianapolis, Indiana., Shah MV; Department of Neurological Surgery, Indiana University-Purdue University, Indianapolis, Indiana., Somasundaram A; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri., Kamath AA; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri., Beaumont TL; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri., Rich KM; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri., Chicoine MR; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.
Jazyk:	angličtina
Zdroj:	Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2019 Mar 01; Vol. 16 (3), pp. 292-301.
DOI:	10.1093/ons/opy108
Abstrakt:	Background: Treatment of deep-seated subcortical intrinsic brain tumors remains challenging and may be improved with trans-sulcal tubular brain retraction techniques coupled with intraoperative magnetic resonance imaging (iMRI). Objective: To conduct a preliminary assessment of feasibility and efficacy of iMRI in tubular retractor-guided resections of intrinsic brain tumors. Methods: Assessment of this technique and impact upon outcomes were assessed in a preliminary series of brain tumor patients from 2 centers. Results: Ten patients underwent resection with a tubular retractor system and iMRI. Mean age was 53.2 ± 9.0 yr (range: 37-61 yr, 80% male). Lesions included 6 gliomas (3 glioblastomas, 1 recurrent anaplastic astrocytoma, and 2 low-grade gliomas) and 4 brain metastases (1 renal cell, 1 breast, 1 lung, and 1 melanoma). Mean maximal tumor diameter was 2.9 ± 0.95 cm (range 1.2-4.3 cm). The iMRI demonstrated subtotal resection (STR) in 6 of 10 cases (60%); additional resection was performed in 5 of 6 cases (83%), reducing STR rate to 2 of 10 cases (20%), with both having tumor encroaching on eloquent structures. Seven patients (70%) were stable or improved neurologically immediately postoperatively. Three patients (30%) had new postoperative neurological deficits, 2 of which were transient. Average hospital length of stay was 3.4 ± 2.0 d (range: 1-7 d). Conclusion: Combining iMRI with tubular brain retraction techniques is feasible and may improve the extent of resection of deep-seated intrinsic brain tumors that are incompletely visualized with the smaller surgical exposure of tubular retractors. (Copyright © 2018 by the Congress of Neurological Surgeons.)
Databáze:	MEDLINE
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