Intraoperative MRI for the management of brain lesions adjacent to eloquent areas

Background. - The aim of our study was to report the usefulness of intraoperative MRI guidance in the resection of brain lesions adjacent to eloquent areas. Patients and methods. - A single center prospective series of gliomas amenable to optimized resection with intraoperative MRI between September 2014 and December 2015. Results. - The study included 56 patients. The median duration of the first intraoperative MRI was 38 min, interquartile range (IQR 30-46). Fourteen patients (40%) underwent a second intraoperative MRI, which had a median duration of 26 min (IQR, 18-30). The median total operative time was 265 min (IQR, 242-337). After the first intraoperative MRI, the median residual glioma volume of the 35 gliomas adjacent to eloquent areas was 7.04 cm(3) (IQR, 2.22-13.8), which did not significantly differ from the other gliomas (P=0.07). After the second intraoperative MRI, the median residual glioma volume was 3.86 cm(3) (IQR, 0.82-6.99), which did not significantly differ from the other patients (P=0.700). On the postoperative MRI, the median extent of the glioma resections adjacent to eloquent areas was 99.78% (IQR, 88.9-100), which was not significantly different from the rest of the population (P=0.290). At 6 months after surgery, the median Karnofsky Performance Score was 90, and 2.8% of the patients presented a permanent new neurological deficit. Conclusion. - Our results suggest that intraoperative MRI is an effective and safe technique to improve the extent of brain lesion resections close to eloquent areas. (C) 2017 Elsevier Masson SAS. All rights reserved.