Impact of intraoperative magnetic resonance imaging and functional neuronavigation on surgical outcome in patients with gliomas involving language areas
Balancing the benefit of extensive tumor resection with the consequence of potential postoperative language deficits remains a challenge in glioma surgery involving language areas. This study is designed to evaluate the impact of intraoperative magnetic resonance imaging (iMRI) and functional neuronavigation on surgical outcome in patients with gliomas involving language areas. Two hundred seventeen patients were prospectively enrolled, 124 in the study group underwent iMRI and functional neuronavigation-guided microsurgery and 93 in the control group underwent conventional navigation-guided microsurgery. Extent of tumor volume resection (EoR) and rate of gross total resection (rGTR) were calculated perioperatively. Aphasia quotient (AQ) was assessed to evaluate the change of language function perioperatively and at 6-month follow-up. Survival outcome for glioblastoma, including progression-free survival (PFS) and overall survival (OS), were recorded. In 198 glioma patients (112 in the study group and 86 in the control group), EoR (95.50 versus 89.85 %, p < 0.001) and rGTR (69.60 versus 47.70 %, p = 0.002) were significantly higher in the study group, and language functions were also better at 6-month follow-up in the study group (87.47 versus 78.73, p = 0.001). Furthermore, postoperative new aphasia occurred in 34.8 % of the control group, whereas it occurred only in 2.3 % of the study group (p < 0.001). In addition, PFS (12.5 versus 6.6 m, p = 0.003) and OS (19.6 versus 13.0 m, p < 0.001) for patients with glioblastomas were dramatically prolonged in the study group than in the control group. These results indicated that iMRI and functional neuronavigation may help maximize tumor resection, minimize language deficits in patients with gliomas involving language areas, and improve survival time for patients with glioblastomas.
KeywordsIntraoperative MRI (iMRI) Functional neuronavigation Glioma surgery Language function Patient survival
We thank all the members of the Department of Neurosurgery, PLA General Hospital, for their collaborative support. This study was supported by the National Natural Science Foundation of China (NSFC 81271515), the Military Clinical High-tech Project (2010gxjs094), and Clinical Support Foundation of Chinese PLA General Hospital (2012FC-TSYS-1015).
The authors have no personal financial or institutional interest in any of the drugs, materials, or devices in this article.
Conflict of interest
The file “preoperative video” showed anomia and conductive aphasia of case 1 before surgery, whereas “postoperative video” demonstrated preoperative aphasia of case 1 was totally recovered before discharge (MPG 30328 kb)
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