Limited Benefit of Intraoperative Low-field Magnetic Resonance Imaging in Craniopharyngioma Surgery

OBJECTIVETo investigate the benefit of intraoperative low-field magnetic resonance imaging (MRI) in craniopharyngioma surgery. METHODSWe used a 0.2-T Magnetom Open scanner (Siemens Medical Solutions, Erlangen, Germany) that was located in a radiofrequency-shielded operating theater for intraoperative MRI. The head of the patient was placed in the fringe field of the scanner, so that standard microinstruments could be used. In transsphenoidal surgery, T1-weighted coronal and sagittal images were acquired. In transcranial surgery, a three-dimensional, gradient echo, T1-weighted, fast low-angle shot sequence was measured, thus allowing multiplanar reformatting. RESULTSA total of 21 surgical procedures in craniopharyngioma patients were investigated. In 10 patients, a bifrontal-translaminar approach was used; in 6 patients, the craniopharyngioma was removed via a transsphenoidal approach; and in 5 patients, intraoperative MRI was used to monitor cyst puncture and aspiration. In the craniotomy group, intraoperative imaging depicted a clear tumor remnant in one patient, which was subsequently removed. In another patient, an area of contrast enhancement was interpreted as artifact; however, postoperative follow-up at 3 months was suspicious for a minor remnant. Two of the eight patients with complete removal developed a recurrence during the follow-up period. In the group of patients who underwent primary transsphenoidal surgery (n = 4), complete removal was estimated by the surgeon in three cases. Intraoperative imaging depicted a remaining tumor in one case, leading to further tumor removal; however, follow-up revealed recurrent cysts. CONCLUSIONIntraoperative low-field MRI allows an ultraearly evaluation of the extent of tumor removal in craniopharyngioma surgery in most cases. Imaging showing an incomplete resection offers the chance for further tumor removal during the same operation. However, intraoperative low-field MRI depicting a complete resection does not exclude craniopharyngioma recurrence.

[1]  Ferenc Jolesz,et al.  Transsphenoidal Resection of Pituitary Adenomas in an Intraoperative MRI Unit , 1999, Pituitary.

[2]  Haiying Liu,et al.  High-Field Strength Interventional Magnetic Resonance Imaging for Pediatric Neurosurgery , 1998, Pediatric Neurosurgery.

[3]  J. Honegger,et al.  Surgical treatment of craniopharyngiomas: endocrinological results. , 1999, Journal of neurosurgery.

[4]  Christopher Nimsky,et al.  Low-field magnetic resonance imaging for intraoperative use in neurosurgery: a 5-year experience , 2002, European Radiology.

[5]  Garnette R Sutherland,et al.  Optimizing Epilepsy Surgery with Intraoperative MR Imaging , 2002, Epilepsia.

[6]  Donald W. Kormos,et al.  Glioma Resection in a Shared-resource Magnetic Resonance Operating Room after Optimal Image-guided Frameless Stereotactic Resection , 2001, Neurosurgery.

[7]  H. Iseki,et al.  Flexible Endoscope-Assisted Endonasal Transsphenoidal Surgery for Pituitary Tumors , 2002, Minimally invasive neurosurgery : MIN.

[8]  T. Schwartz,et al.  Standardization of Amygdalohippocampectomy with Intraoperative Magnetic Resonance Imaging: Preliminary Experience , 2002, Epilepsia.

[9]  E. Laws,et al.  MR of the pituitary gland postsurgery: serial MR studies following transsphenoidal resection. , 1993, AJNR. American journal of neuroradiology.

[10]  J. Honegger,et al.  Progesterone receptor gene expression in craniopharyngiomas and evidence for biological activity. , 1997, Neurosurgery.

[11]  R. van Effenterre,et al.  Craniopharyngioma in adults and children: a study of 122 surgical cases. , 2002, Journal of neurosurgery.

[12]  N. Hata,et al.  Serial Intraoperative Magnetic Resonance Imaging of Brain Shift , 2001, Neurosurgery.

[13]  J. Honegger,et al.  Surgical treatment of craniopharyngiomas: experience with 168 patients. , 1999, Journal of neurosurgery.

[14]  T. Carroll.  Achieving Gross Total Resection of Brain Tumors: Intraoperative MR Imaging Can Make a Big Difference , 2002 .

[15]  C R Wirtz,et al.  Intraoperative MR imaging increases the extent of tumor resection in patients with high-grade gliomas. , 1999, AJNR. American journal of neuroradiology.

[16]  F A Jolesz,et al.  Intra‐operative MR guidance during trans‐sphenoidal pituitary resection: Preliminary results , 2001, Journal of magnetic resonance imaging : JMRI.

[17]  B. Bergquist.  Craniotomy for tumor treatment in an intraoperative magnetic resonance imaging unit. , 2000, Neurosurgery.

[18]  C. Nimsky,et al.  Intraoperative Magnetic Resonance Imaging Combined with Neuronavigation: A New Concept , 2001, Neurosurgery.

[19]  R Kikinis,et al.  Intraoperative MR imaging guidance for intracranial neurosurgery: experience with the first 200 cases. , 1999, Radiology.

[20]  D. Louw,et al.  A mobile high-field magnetic resonance system for neurosurgery. , 1999, Journal of neurosurgery.

[21]  T. Maruyama,et al.  Age-related changes in the proportion of intracranial cerebrospinal fluid space measured using volumetric computerized tomography scanning. , 2002, Journal of neurosurgery.

[22]  M M Bonsanto,et al.  Clinical evaluation and follow-up results for intraoperative magnetic resonance imaging in neurosurgery. , 2000, Neurosurgery.

[23]  C. Nimsky,et al.  Glioma surgery evaluated by intraoperative low-field magnetic resonance imaging. , 2003, Acta neurochirurgica. Supplement.

[24]  R. Carrau,et al.  Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. , 1996, Journal of neurosurgery.

[25]  C. Nimsky,et al.  Quantification of, Visualization of, and Compensation for Brain Shift Using Intraoperative Magnetic Resonance Imaging , 2000, Neurosurgery.

[26]  O. Ganslandt,et al.  How to implement high-field intraoperative magnetic resonance imaging , 2002 .

[27]  S. Hushek,et al.  Changes in Cyst Volume following Intraoperative MRI-Guided Ommaya Reservoir Placement for Cystic Craniopharyngioma , 2001, Pediatric Neurosurgery.

[28]  V. Tronnier,et al.  Intraoperative magnetic resonance imaging to update interactive navigation in neurosurgery: method and preliminary experience. , 1997, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[29]  J. Honegger,et al.  Human chorionic gonadotrophin immunoactivity in cystic intracranial tumours , 1995, Clinical endocrinology.

[30]  Abel Cuevas-Solórzano,et al.  Multimodal management of craniopharyngiomas: neuroendoscopy, microsurgery, and radiosurgery. , 2002, Journal of neurosurgery.

[31]  W. Hall,et al.  Intra-Operative MRI-Guided Approaches to the Pediatric Posterior Fossa Tumors , 2001, Pediatric Neurosurgery.

[32]  R. Kikinis,et al.  Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications. , 1997, Neurosurgery.

[33]  R. Bernays,et al.  Intraoperative diagnostic and interventional magnetic resonance imaging in neurosurgery. , 1997, Neurosurgery.

[34]  C. Nimsky,et al.  Intraoperative magnetic resonance imaging with the magnetom open scanner: concepts, neurosurgical indications, and procedures: a preliminary report. , 1998, Neurosurgery.

[35]  D W Kormos,et al.  Intraoperative Magnetic Resonance Imaging to Determine the Extent of Resection of Pituitary Macroadenomas during Transsphenoidal Microsurgery , 2001, Neurosurgery.

[36]  Intraoperative computed tomographic scanning during transsphenoidal surgery: technical note. , 1993, Neurosurgery.

[37]  C. Nimsky,et al.  Use of Intraoperative Magnetic Resonance Imaging in Tailored Temporal Lobe Surgeries for Epilepsy , 2002, Epilepsia.

[38]  C. Nimsky,et al.  Intraoperative compensation for brain shift. , 2001, Surgical neurology.

[39]  O Ganslandt,et al.  Intraoperative magnetic resonance imaging during transsphenoidal surgery. , 2001, Journal of neurosurgery.

[40]  S Kellermann,et al.  Gross-total surgery of supratentorial low-grade gliomas under intraoperative MR guidance. , 2001, AJNR. American journal of neuroradiology.

[41]  P. Hsieh,et al.  Endoscope-Assisted Microsurgery for Treatment of a Suprasellar Craniopharyngioma Presenting Precocious Puberty , 2001, Pediatric Neurosurgery.