Low-grade Insular Glioma Resection with 1.5T Intra-operative MRI: Preliminary Results of a Prospective Randomized Trial

Keywords: image guidance, insular tumor, magnetic resonance imaging, glioma, randomized trial

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     Although more aggressive resection and higher extent of resection (EoR) of low-grade gliomas (LGGs) may result in longer survival of the patients, aggressive resection of insular LGGs remains challenging due to tumors’ relationship with complex surrounding functional structures.
     To provide high-class evidence regarding the impact of 1.5T intra-operative MRI (iMRI) on the resection of insular LGGs, we conducted a prospective randomized trial.
     Adult patients with non-contrast-enhancing insular lesions suspicious of LGGs were eligible to enter this trial.
     Patients were randomized to undergo either iMRI guided or conventional micro-neurosurgical tumor resection. For the iMRI group, pre- and intra-operative 1.5T MRI images were obtained to perform volumetric analyses to assess the EoR. For the control group, both pre- and early post-operative 1.5T MRI images were acquired. After the inclusion of 81 patients (iMRI group, 40 cases; control group, 41 cases), we performed a preliminary analysis.
     There were no significant differences in patient age (p=0.32) or preoperative tumor sizes (p=0.47) between the two treatment groups. EoR was significantly higher, and postoperative tumor volume was significantly lower in the iMRI group than in the control group (p<0.05). On the other hand, post-operative long-term (<3months) morbidity was significantly lower in the iMRI group than in the control group (p<0.05).
     This is a prospective single-center study.
     The use of iMRI appears to be associated with a higher rate of gross total as well as sub-total tumor resections compared to conventional microneurosurgery.
     Aggressive resection of insular LGGs with iMRI didn’t increase the long-term morbidity.


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