Craniotomy for Tumor Treatment in an Intraoperative Magnetic Resonance Imaging Unit
| Autor: | Richard B. Schwartz, Claudia Martin, Eben Alexander, Arya Nabavi, Terence Z. Wong, Thomas M. Moriarty, Ferenc A. Jolesz, Peter McL. Black |
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| Rok vydání: | 1999 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Astroblastoma Brain tumor Pineal Gland Intraoperative MRI Monitoring Intraoperative Glioma Meningeal Neoplasms medicine Medical imaging Humans Craniotomy Aged Retrospective Studies medicine.diagnostic_test Brain Neoplasms business.industry Brain Supratentorial Neoplasms Magnetic resonance imaging Middle Aged medicine.disease Magnetic Resonance Imaging Neoplasms Neuroepithelial Surgery Image-guided surgery Female Neurology (clinical) Radiology Meningioma business Pinealoma |
| Zdroj: | Neurosurgery. 45:423-433 |
| ISSN: | 1524-4040 0148-396X |
| Popis: | OBJECTIVE: The complex three-dimensional anatomic features of the brain and its vulnerability to surgical intervention make the surgical treatment of intracranial tumors challenging. We evaluated the surgical treatment of supratentorial tumors using intraoperative magnetic resonance imaging (MRI), which provides real-time guidance, allows localization of intracranial tumors and their margins, and facilitates continuous assessment of surgical progress. METHODS: Sixty patients underwent craniotomies for tumor treatment in the General Electric intraoperative MRI unit at the Brigham and Women's Hospital (Boston, MA) during a 1-year period. The patients selected were those with intracranial tumors that were considered difficult to resect because of their locations or previous incomplete operations. Twenty-nine low-grade and 19 high-grade gliomas, 8 metastatic lesions, 2 meningiomas, 1 pineoblastoma, and 1 astroblastoma were resected. RESULTS: Tumors were accurately localized and targeted, and the extent of resection, as well as any intraoperative complications, could be immediately assessed during surgery. Marked brain shifting occurred during the procedures, and repeated intraoperative imaging allowed surgical accommodation for this shifting. In more than one-third of the cases, intraoperative imaging showed residual tumor when resection appeared complete on the basis of surgical observation alone. CONCLUSION: Intraoperative MRI is a revolutionary tool for the surgical treatment of brain tumors, providing observation of the procedure as it is being performed. With intraoperative MRI, tumor resection is safer, the extent of resection can be directly evaluated, and intraoperative complications can be noted if they occur. Outcomes after resection depend on minimizing injury to normal brain tissue and achieving maximal tumor resection. The use of intraoperative MRI directly affects these factors. |
| Databáze: | OpenAIRE |
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