Impact of Intraoperative Magnetic Resonance Imaging and Functional Neuronavigation on Tumor Resection and Function Preservation: a Prospective, Controlled Study in Patients with Gliomas Involving Language Cortex.

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     This study is designed to evaluate the impact of intraoperative magnetic resonance imaging (iMRI) and functional neuronavigation (FN) on the extent of resection and language function preservation for gliomas involving language cortex.
     111 consecutive patients with cerebral gliomas involving language areas were prospectively enrolled between 2009 and 2011. The patients were divided into study group (n=73) and control group (n=38).
     The Aphasia Quotients (AQ) were obtained preoperatively, postoperatively and 3-month follow-up. To assess the extents of tumor resection, MRI were scanned postoperatively within 48 hours (T1 contrast and T2 FLAIR for high and low grade gliomas respectively). Anatomical MRI, blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) and diffusion tensor imaging were routinely performed preoperatively for the study group, followed by iMRI and neuronavigation-guided tumor resection. The control group underwent operations with conventional anatomical navigation.
     In 41.2% (28/68) of patients in the study group, iMRI revealed residual tumors which resulted in further resection. Gross total removal rate of the study group were significantly higher than that of the control group (94.1% versus 64.5%, P<0.01). For function preservation, the AQs(AQ=AQpostop-AQpreop) of the study group were significantly higher than those of the control group(-1.25 versus -9.99, P<0.01). Furthermore, postoperative new aphasia occurred in 40% (4/10) of the control group, while in the study group, it occurred only in 1 case (4.2%, P < 0.01).
     This is a prospective study.
     The iMRI and FN may help to maximize tumor resection.
     Also it may help to minimize language deficits for the resection of gliomas involving eloquent language cortex.


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