Low-grade Insular Glioma Resection with 1.5T Intra-operative MRI: Preliminary Results of a Prospective Randomized TrialKeywords: image guidance, insular tumor, magnetic resonance imaging, glioma, randomized trialInteractive Manuscript
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What is the background behind your study?
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.
What is the purpose of your study?
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.
Describe your patient group.
Adult patients with non-contrast-enhancing insular lesions suspicious of LGGs were eligible to enter this trial.
Describe what you did.
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.
Describe your main findings.
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).
Describe the main limitation of this study.
This is a prospective single-center study.
Describe your main conclusion.
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.
Describe the importance of your findings and how they can be used by others.
Aggressive resection of insular LGGs with iMRI didn’t increase the long-term morbidity.
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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