Introduction: The surgical resection of low grade gliomas (LGG) remains challenging. The need for gross total or maximal resection remains controversial but has become more accepted within the Neurosurgical community worldwide. The most definitive indication for the use of intraoperative MRI is for the resection of LGG. Australia’s first iMRI operating suite has been functional since 2007 at Sydney’s Royal Prince Alfred Hospital (RPA). This is the first Australian study of iMRI guided surgery and is one of the largest studies in the world, on this topic.
Aim: To investigate the degree of resection achieved and post-operative neurological deficit rate amongst LGG patient who undergo iMRI guided surgery.
Methods: A retrospective audit was performed on all LGG surgeries performed in the iMRI operating suite with respect to the following endpoints:
Primary endpoints: extent of resection, incidence of new or worsened neurological deficit after surgery, operating time, number of scans per case, and other post operative complications.
Secondary endpoints: reduction in preoperative symptoms, including seizure frequency.
Results: Since 2007, a total of 292 patients were operated on in the BrainSuite at RPA. Of these, 36 patients had a low grade glioma (WHO grade II). Median patient age was 40 years. Gross total resection was achieved in 63% of patients, of which, 53% was due to iMRI detection of residual tumour. 100% of patients with seizures reported symptom improvement. 5 patients experienced new or worsened neurological deficits. A median of 2 scans was performed during the operations. Average operative time was 6.3 hours.
Conclusions: iMRI surgery for LGG provides a safe and effective way to achieve maximal resection.
Patient Care: This research demonstrates that iMRI guidance is an effective and safe method of treating Low Grade Gliomas (LGG). This research presents evidence that, compared with conventional surgery, image guided neurosurgery can achieve a greater extent of resection in LGG and hence improve patient prognosis and quality of life, whilst minimising the risk of post-operative complications.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Identify iMRI guidance as a safe and effective method of treating Low Grade Gliomas (LGG)
2) Describe and compare the Extent of Resection achieved in iMRI guided LGG surgery against conventional LGG microsurgery
3) Describe the complications and complication rates of iMRI guided LGG surgery