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Benefit of 1.5-T intraoperative MR imaging in the surgical treatment of craniopharyngiomas

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Abstract

Background

As low-field magnetic resonance imaging (MRI) has very limited significance for intraoperative control of total tumor removal (TTR), we examined the influence of 1.5-T MRI, incorporating higher resolution into the intraoperative strategy of craniopharyngioma surgery.

Methods

Surgery with intraoperative imaging was performed in 25 selected patients in whom tumor resection was anticipated to be difficult according to pre-operative findings.

Results

Intraoperative MRI confirmed the intended extent of tumor removal in 15 patients (14 TTRs, one intended incomplete removal, while a second procedure was scheduled due to complex shape). Misinterpretation was false positive or negative in one patient each. The extent of removal was not achieved as expected in eight patients (expectation: seven TTRs, one incomplete removal). In three patients, the expected TTR was achieved by resuming surgery. In another case, that goal was accomplished by performing an unscheduled second procedure. In total, by using intraoperative imaging, the rate of TTR was increased by 16% (four patients), leading to 80% in the entire series. Compared with the literature, the rate of new ophthalmologic and endocrine deficits is acceptable; the rate of other surgical complication is slightly higher but not directly caused by intraoperative imaging.

Conclusion

Intraoperative 1.5-T MRI provides benefits because of good early prediction of TTR (sensitivity, positive predictive value: 93.8%; specificity, negative predictive value: 88.9%) and a low rate of false-positive results. Moreover, extended resection of remnants visualized is enabled and helps to increase the rate of TTR but does not exclude recurrence.

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Acknowledgements

We wish to thank Prof. Blümcke and Dr. Buslei, Department of Neuropathology, University of Erlangen-Nuremberg for histopathological workup, Prof. Huk and Prof. Dörfler, Department of Neuroradiology, University of Erlangen-Nuremberg for providing MRI scans as well as the Department of Ophthalmology and the technicians of the Neuroendocrine Laboratory and the Intraoperative Imaging Suite. Furthermore, we are indebted to Mr. F. Bittner for providing the illustrations and Prof. M Klinger for revising the manuscript.

R.F. changed to the International Neuroscience Institute, Hanover in 2005, C.N. to the University of Marburg in 2008.

Financial disclosure

One author (B.M.H.) is an employee of Siemens AG Healthcare Sector since September 2006 but has not received any financial support to conduct this study.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Halle/Saale, Halle, Germany

    Bernd M. Hofmann

  2. Department of Neurosurgery, Philipps-Universität, Marburg, Germany

    Christopher Nimsky

  3. International Neuroscience Institute, Hannover, Germany

    Rudolf Fahlbusch

  4. Siemens AG Healthcare Sector, Allee am Röthelheimpark 3a, 91052, Erlangen, Germany

    Bernd M. Hofmann

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  1. Bernd M. Hofmann
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  2. Christopher Nimsky
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Correspondence to Bernd M. Hofmann.

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Comment

This manuscript confirms the utility of intraoperative MRI to improve the accuracy of tumor resection in craniopharyngioma surgery. Based upon our experience of endoscopic endonasal management of these lesions, it could be argued that the endoscopic exploration could be sufficient to detect any remnant. However, if it is true in most of the cases, it has to be considered that craniopharyngiomas with bigger and bigger sizes and asymmetric pattern of growth are operated on via this latter route. In these conditions, where an increased risk of leaving remnants could be feared, the intraoperative MRI could be really useful. Though, if on the one hand the use of neuronavigation systems helps in defining a tailored approach to the lesion, on the other the use of intraoperative MRI provides relevant, more detailed information concerning the lesion removal while the surgical procedure is still going on. Each surgical procedure represents a different challenge that is not worth performing twice in the same way. Therefore, in such a delicate field, we think that the authors’ experience contributes and favours the adoption of such a tool to improve the efficacy and the safety of the surgical approaches to craniopharyngiomas.

Paolo Cappabianca

Napoli, Italy

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Hofmann, B.M., Nimsky, C. & Fahlbusch, R. Benefit of 1.5-T intraoperative MR imaging in the surgical treatment of craniopharyngiomas. Acta Neurochir 153, 1377–1390 (2011). https://doi.org/10.1007/s00701-011-0973-x

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  • DOI: https://doi.org/10.1007/s00701-011-0973-x

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