title: Gross-total surgery of supratentorial low-grade gliomas under intraoperative MR guidance.
abstract: OBJECTIVE
  Length of survival of patients with low-grade glioma correlates with the extent of tumor resection. These tumors, however, are difficult to distinguish intraoperatively from normal brain tissue, often leading to incomplete resection. Our goal was to evaluate the effectiveness of intraoperative MR guidance in achieving gross-total resection.
  
  
  METHODS
  We studied 12 patients with low-grade glioma who underwent surgery within a vertically open 0.5-T MR system. During surgery, localization of residual tumor tissue was guided by interactive, near real-time imaging. The amount of residual tumor tissue on MR images was evaluated at the point of the operation at which the neurosurgeon would have terminated the procedure under conventional conditions (first control) and again before closing the craniotomy.
  
  
  RESULTS
  Significant residual tumor (more than 10% of original tumor volume) was shown in eight patients at the first control condition. The percentage of resection varied from 26% to 100% (mean, 68%) at this time. Twelve tissue samples from seven patients were obtained in areas identified as residual tumor on MR images. In 10 cases, the neuropathologic investigation confirmed the presence of residual low-grade glioma; in two cases, the borderzone of tumor was identified. In evaluating the final sets of images, we found total resection in six cases, over 90% resection in five cases, and 85% resection in one case (mean, 96%).
  
  
  CONCLUSIONS
  Surgical treatment of low-grade gliomas under intraoperative MR guidance provides improved resection results with maximal patient safety.
authors.affiliation: Department of Diagnostic Radiology, University of Leipzig, Germany.
authors.forename: J P
authors.initials: JP
authors.lastname: Schneider
authors.forename: T
authors.initials: T
authors.lastname: Schulz
authors.forename: F
authors.initials: F
authors.lastname: Schmidt
authors.forename: J
authors.initials: J
authors.lastname: Dietrich
authors.forename: S
authors.initials: S
authors.lastname: Lieberenz
authors.forename: C
authors.initials: C
authors.lastname: Trantakis
authors.forename: V
authors.initials: V
authors.lastname: Seifert
authors.forename: S
authors.initials: S
authors.lastname: Kellermann
authors.forename: R
authors.initials: R
authors.lastname: Schober
authors.forename: L
authors.initials: L
authors.lastname: Schaffranietz
authors.forename: M
authors.initials: M
authors.lastname: Laufer
authors.forename: T
authors.initials: T
authors.lastname: Kahn
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques / Q000592:standards*; D016896:Treatment Outcome