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Titolo:
Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection
Autore:
Bohinski, RJ; Kokkino, AK; Warnick, RE; Gaskill-Shipley, MF; Kormos, DW; Lukin, RR; Tew, JM;
Indirizzi:
Univ Cincinnati, Coll Med, Dept Neurosurg, Editorial Off,Neurosci Inst, Cincinnati, OH 45267 USA Univ Cincinnati Cincinnati OH USA 45267 ci Inst, Cincinnati, OH 45267 USA Univ Cincinnati, Coll Med, Inst Neurosci, Dept Radiol, Cincinnati, OH 45267 USA Univ Cincinnati Cincinnati OH USA 45267 Radiol, Cincinnati, OH 45267 USA Mayfield Clin, Cincinnati, OH USA Mayfield Clin Cincinnati OH USAMayfield Clin, Cincinnati, OH USA Amer Inc, Hitachi Med Syst, Twinsburg, OH USA Amer Inc Twinsburg OH USAAmer Inc, Hitachi Med Syst, Twinsburg, OH USA
Titolo Testata:
NEUROSURGERY
fascicolo: 4, volume: 48, anno: 2001,
pagine: 731 - 742
SICI:
0148-396X(200104)48:4<731:GRIASM>2.0.ZU;2-1
Fonte:
ISI
Lingua:
ENG
Soggetto:
MALIGNANT GLIOMAS; RESIDUAL TUMOR; FOLLOW-UP; NEUROSURGERY; MR; SURGERY; EXTENT; NEURONAVIGATION; DEFORMATION; CRANIOTOMY;
Keywords:
brain neoplasms; glioma; image-guided surgery; intraoperative magnetic resonance imaging; neuronavigation;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
34
Recensione:
Indirizzi per estratti:
Indirizzo: Warnick, RE Univ Cincinnati, Coll Med, Dept Neurosurg, Editorial Off,Neurosci Inst, 231 Bethesda Ave,POB 670515, Cincinnati, OH 45267 USA Univ Cincinnati 231 Bethesda Ave,POB 670515 Cincinnati OH USA 45267
Citazione:
R.J. Bohinski et al., "Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection", NEUROSURGER, 48(4), 2001, pp. 731-742

Abstract

OBJECTIVE: We describe a shared-resource intraoperative magnetic resonanceimaging (MRI) design that allocates time for both surgical procedures and routine diagnostic imaging. We investigated the safety and efficacy of thisdesign as applied to the detection of residual glioma immediately after anoptimal image-guided frameless stereotactic resection (IGFSR). METHODS: Based on the twin operating rooms (ORs) concept, we installed a commercially available Hitachi AIRIS II, 0.3-tesla, vertical field, open MRIunit in its own specially designed OR (designated the magnetic resonance OR) immediately adjacent to a conventional neurosurgical OR. Between May 1998 and October 1999, this facility was used for both routine diagnostic imaging (969 diagnostic scans) and surgical procedures (50 craniotomies for tumor resection, 27 transsphenoidal explorations, and 5 biopsies). Our study group, from which prospective data were collected, consisted of 40 of these patients who had glioma (World Health Organization Grades II-IV). These 40 patients first underwent optimal IGFSRs in the adjacent conventional OR, where resection continued until the surgeon believed that all of the accessible tumor had been removed. Patients were then transferred to the magnetic resonance OR to check the completeness of the resection. If accessible residual tumor was observed, then a biopsy and an additional resection were performed. To validate intraoperative MRI findings, early postoperative MRI using a 1.5-tesla magnet was performed. RESULTS: Intraoperative images that were suitable for interpretation were obtained for all 40 patients after optimal IGFSRs. In 19 patients (47%), intraoperative MRI studies confirmed that adequate resection had been achieved after IGFSR alone. Intraoperative MRI studies showed accessible residual tumors in the remaining 21 patients (53%), all of whom underwent additionalresections. Early postoperative MRI studies were obtained in 39 patients, confirming that the desired final extent of resection had been achieved in all of these patients. One patient developed a superficial wound infection,and no hazardous equipment or instrumentation problems occurred. CONCLUSION: Use of an intraoperative MRI facility that permits both diagnostic imaging and surgical procedures is safe and may represent a more cost-effective approach than dedicated intraoperative units for some hospital centers. Although we clearly demonstrate an improvement in volumetric glioma resection as compared with IGFSR alone, further study is required to determine the impact of this approach on patient survival.

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Documento generato il 04/04/20 alle ore 11:58:35