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Utilization of Movable High Field Strength Intraoperative Magnetic Resonance Imaging with Awake Craniotomies for Resection of Gliomas. A Preliminary Experience.
MedLine Citation:
PMID:  21499143     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Awake craniotomy with electrocortical mapping and intraoperative magnetic resonance imaging (iMRI) are established techniques for maximizing tumor resection and preserving function, but there has been little experience combining these methodologies. OBJECTIVE:: We report our experience of combining awake craniotomy and iMRI with a 1.5 Tesla movable iMRI for resection of gliomas in close proximity to eloquent cortex. METHODS:: Twelve patients (9 male, 3 female, ages 32-60 years, mean 41 years) undergoing awake craniotomy and iMRI for glioma resections were identified from a prospective database. Assessments were made of how these two modalities were integrated, and what impact this strategy had upon safety, surgical decision making, work flow, operative time, extent of tumor resection and outcome. RESULTS:: Twelve craniotomies were safely performed in an operating room equipped with a movable 1.5 Tesla iMRI. The extent of resection was limited because of proximity to eloquent areas in 5 cases: language areas in 3 patients and motor areas in 2 patients. Additional tumor was identified and resected after iMRI in 6 cases. Average operating room time was 7.9 hours (range 5.9 - 9.7). In comparison to preoperative neurological function, immediate postoperative function was stable/improved in 7 and worse in 5, and after 30 days was stable/improved in 11 and worse in 1. CONCLUSION:: Awake craniotomy and iMRI with a movable high field strength device can be safely performed to maximize resection of tumors near eloquent language areas.
Authors:
Eric C Leuthardt; Chris Ch Lim; Manish N Shah; John A Evans; Keith M Rich; Ralph G Dacey; Rene Tempelhoff; Michael R Chicoine
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-14
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1 Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, 63110 2 Department of Anesthesia, Washington University School of Medicine, St. Louis, MO, 63110 3Department of Biomedical Engineering, Washington University in St. Louis, St Louis, MO, 63110 4Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.
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