Glioma surgery using a multimodal navigation system with integrated metabolic images.
OBJECTIVE
A multimodal neuronavigation system using metabolic images with PET and anatomical images from MR images is described here for glioma surgery. The efficacy of the multimodal neuronavigation system was evaluated by comparing the results with that of the conventional navigation system, which routinely uses anatomical images from MR and CT imaging as guides.


METHODS
Thirty-three patients with cerebral glioma underwent 36 operations with the aid of either a multimodal or conventional navigation system. All of the patients were preliminarily examined using PET with l-methyl-[11C] methionine (MET) for surgical planning. Seventeen of the operations were performed with the multimodal navigation system by integrating the MET-PET images with anatomical MR images. The other 19 operations were performed using a conventional navigation system based solely on MR imaging.


RESULTS
The multimodal navigation system proved to be more useful than the conventional navigation system in determining the area to be resected by providing a clearer tumor boundary, especially in cases of recurrent tumor that had lost a normal gyral pattern. The multimodal navigation system was therefore more effective than the conventional navigation system in decreasing the mass of the tumor remnant in the resectable portion. A multivariate regression analysis revealed that the multimodal navigation system-guided surgery benefited patient survival significantly more than the conventional navigation-guided surgery (p = 0.016, odds ratio 0.52 [95% confidence interval 0.29-0.88]).


CONCLUSIONS
The authors' preliminary intrainstitutional comparison between the 2 navigation systems suggested the possible premise of multimodal navigation. The multimodal navigation system using MET-PET fusion imaging is an interesting technique that may prove to be valuable in the future.
Department of Neurosurgery, Graduate School, Tokyo Medical and Dental University, Bunkyo-ku, Japan.
Yoji
Y
Tanaka
Tadashi
T
Nariai
Toshiya
T
Momose
Masaru
M
Aoyagi
Taketoshi
T
Maehara
Toshiki
T
Tomori
Yoshikazu
Y
Yoshino
Tsukasa
T
Nagaoka
Kiichi
K
Ishiwata
Kenji
K
Ishii
Kikuo
K
Ohno
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000378:metabolism / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008715:Methionine / Q000031:analogs & derivatives; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods*; D049268:Positron-Emission Tomography; D011182:Postoperative Care; D019275:Radiopharmaceuticals; D012044:Regression Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D008715:Methionine; C038344:methionine methyl ester