Awake craniotomy for gliomas in a high-field intraoperative magnetic resonance imaging suite: analysis of 42 cases

Clinical article

View More View Less
  • 1 Departments of Neurosurgery,
  • 2 Neuro-Oncology and
  • 3 Anesthesiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The object of this study was to describe the experience of combining awake craniotomy techniques with high-field (1.5 T) intraoperative MRI (iMRI) for tumors adjacent to eloquent cortex.

Methods

From a prospective database the authors obtained and evaluated the records of all patients who had undergone awake craniotomy procedures with cortical and subcortical mapping in the iMRI suite. The integration of these two modalities was assessed with respect to safety, operative times, workflow, extent of resection (EOR), and neurological outcome.

Results

Between February 2010 and December 2011, 42 awake craniotomy procedures using iMRI were performed in 41 patients for the removal of intraaxial tumors. There were 31 left-sided and 11 right-sided tumors. In half of the cases (21 [50%] of 42), the patient was kept awake for both motor and speech mapping. The mean duration of surgery overall was 7.3 hours (range 4.0–13.9 hours). The median EOR overall was 90%, and gross-total resection (EOR ≥ 95%) was achieved in 17 cases (40.5%). After viewing the first MR images after initial resection, further resection was performed in 17 cases (40.5%); the mean EOR in these cases increased from 56% to 67% after further resection. No deficits were observed preoperatively in 33 cases (78.5%), and worsening neurological deficits were noted immediately after surgery in 11 cases (26.2%). At 1 month after surgery, however, worsened neurological function was observed in only 1 case (2.3%).

Conclusions

There was a learning curve with regard to patient positioning and setup times, although it did not adversely affect patient outcomes. Awake craniotomy can be safely performed in a high-field (1.5 T) iMRI suite to maximize tumor resection in eloquent brain areas with an acceptable morbidity profile at 1 month.

Abbreviations used in this paper:DTI = diffusion tensor imaging; DWI = diffusion-weighted imaging; EOR = extent of resection; fMRI = functional MRI; GTR = gross-total resection; iMRI = intraoperative MRI; LMA = laryngeal mask airway; OR = operating room; PR = partial resection; STR = subtotal resection.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Sujit S. Prabhu, M.D., F.R.C.S., Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030. email: sprabhu@mdanderson.org.

Please include this information when citing this paper: published online August 8, 2014; DOI: 10.3171/2014.6.JNS132285.

  • 1

    Berger MS, , Deliganis AV, , Dobbins J, & Keles GE: The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 74:17841791, 1994

    • Search Google Scholar
    • Export Citation
  • 2

    Bernstein M, , Al-Anazi AR, , Kucharczyk W, , Manninen P, , Bronskill M, & Henkelman M: Brain tumor surgery with the Toronto open magnetic resonance imaging system: preliminary results for 36 patients and analysis of advantages, disadvantages, and future prospects. Neurosurgery 46:900909, 2000

    • Search Google Scholar
    • Export Citation
  • 3

    Goebel S, , Nabavi A, , Schubert S, & Mehdorn HM: Patient perception of combined awake brain tumor surgery and intraoperative 1.5-T magnetic resonance imaging: the Kiel experience. Neurosurgery 67:594600, 2010

    • Search Google Scholar
    • Export Citation
  • 4

    Hatiboglu MA, , Weinberg JS, , Suki D, , Rao G, , Prabhu SS, & Shah K, : Impact of intraoperative high-field magnetic resonance imaging guidance on glioma surgery: a prospective volumetric analysis. Neurosurgery 64:10731081, 2009

    • Search Google Scholar
    • Export Citation
  • 5

    Hatiboglu MA, , Weinberg JS, , Suki D, , Tummala S, , Rao G, & Sawaya R, : Utilization of intraoperative motor mapping in glioma surgery with high-field intraoperative magnetic resonance imaging. Stereotact Funct Neurosurg 88:345352, 2010

    • Search Google Scholar
    • Export Citation
  • 6

    Huncke K, , Van de Wiele B, , Fried I, & Rubinstein EH: The asleep-awake-asleep anesthetic technique for intraoperative language mapping. Neurosurgery 42:13121317, 1998

    • Search Google Scholar
    • Export Citation
  • 7

    Keles GE, , Lamborn KR, & Berger MS: Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome. J Neurosurg 95:735745, 2001

    • Search Google Scholar
    • Export Citation
  • 8

    Kim SS, , McCutcheon IE, , Suki D, , Weinberg JS, , Sawaya R, & Lang FF, : Awake craniotomy for brain tumors near eloquent cortex: correlation of intraoperative cortical mapping with neurological outcomes in 309 consecutive patients. Neurosurgery 64:836846, 2009

    • Search Google Scholar
    • Export Citation
  • 9

    Kumar VA, , Hamilton J, , Hayman LA, , Kumar AJ, , Rao G, & Weinberg JS, : Deformable anatomic templates improve analysis of gliomas with minimal mass effect in eloquent areas. Neurosurgery 73:534542, 2013

    • Search Google Scholar
    • Export Citation
  • 10

    Lacroix M, , Abi-Said D, , Fourney DR, , Gokaslan ZL, , Shi W, & DeMonte F, : A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95:190198, 2001

    • Search Google Scholar
    • Export Citation
  • 11

    Leuthardt EC, , Lim CC, , Shah MN, , Evans JA, , Rich KM, & Dacey RG, : Use of movable high-field-strength intraoperative magnetic resonance imaging with awake craniotomies for resection of gliomas: preliminary experience. Neurosurgery 69:194206, 2011

    • Search Google Scholar
    • Export Citation
  • 12

    Nabavi A, , Goebel S, , Doerner L, , Warneke N, , Ulmer S, & Mehdorn M: Awake craniotomy and intraoperative magnetic resonance imaging: patient selection, preparation, and technique. Top Magn Reson Imaging 19:191196, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Parney IF, , Goerss SJ, , McGee K, , Huston J III, , Perkins WJ, & Meyer FB: Awake craniotomy, electrophysiologic mapping, and tumor resection with high-field intraoperative MRI. World Neurosurg 73:547551, 2010

    • Search Google Scholar
    • Export Citation
  • 14

    Peruzzi P, , Puente E, , Bergese S, & Chiocca EA: Intraoperative MRI (ioMRI) in the setting of awake craniotomies for supratentorial glioma resection. Acta Neurochir Suppl 109:4348, 2011

    • Search Google Scholar
    • Export Citation
  • 15

    Prabhu SS, , Gasco J, , Tummala S, , Weinberg JS, & Rao G: Intraoperative magnetic resonance imaging-guided tractography with integrated monopolar subcortical functional mapping for resection of brain tumors. Clinical article. J Neurosurg 114:719726, 2011

    • Search Google Scholar
    • Export Citation
  • 16

    Sanai N, , Mirzadeh Z, & Berger MS: Functional outcome after language mapping for glioma resection. N Engl J Med 358:1827, 2008

  • 17

    Sanai N, , Polley MY, , McDermott MW, , Parsa AT, & Berger MS: An extent of resection threshold for newly diagnosed glioblastomas. Clinical article. J Neurosurg 115:38, 2011

    • Search Google Scholar
    • Export Citation
  • 18

    Schneider JP, , Trantakis C, , Rubach M, , Schulz T, , Dietrich J, & Winkler D, : Intraoperative MRI to guide the resection of primary supratentorial glioblastoma multiforme—a quantitative radiological analysis. Neuroradiology 47:489500, 2005

    • Search Google Scholar
    • Export Citation
  • 19

    Senft C, , Bink A, , Franz K, , Vatter H, , Gasser T, & Seifert V: Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 12:9971003, 2011

    • Search Google Scholar
    • Export Citation
  • 20

    Serletis D, & Bernstein M: Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors. J Neurosurg 107:16, 2007

    • Search Google Scholar
    • Export Citation
  • 21

    Shi WM, , Wildrick DM, & Sawaya R: Volumetric measurement of brain tumors from MR imaging. J Neurooncol 37:8793, 1998

  • 22

    Takrouri MS, , Shubbak FA, , Al Hajjaj A, , Del Maaestro RF, , Soualmi L, & Alkhodair MH, : Conscious sedation for awake craniotomy in intra-operative magnetic resonance imaging operating theatre (IMRI OT) environment. Middle East J Anaesthesiol 20:885890, 2010

    • Search Google Scholar
    • Export Citation
  • 23

    Tan TK, & Leong KW: Awake craniotomy in an intra-operative MRI environment. Anaesthesia 64:575576, 2009

  • 24

    Weingarten DM, , Asthagiri AR, , Butman JA, , Sato S, , Wiggs EA, & Damaska B, : Cortical mapping and frameless stereotactic navigation in the high-field intraoperative magnetic resonance imaging suite. Technical note. J Neurosurg 111:11851190, 2009

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 291 291 48
Full Text Views 770 171 5
PDF Downloads 338 93 1
EPUB Downloads 0 0 0