Transoperative Magnetic Resonance Imaging in awake glioma surgery: Experience in a Latin American tertiary-level center

Abstract

Objective: Analyze the usefulness, efficacy, and safety of transoperative Magnetic Resonance Imaging in glioma surgery in awake patients.

Materials and methods: Retrospective, single-center, analytical study of a cohort of patients who underwent awake surgery for gliomas by the same surgeon in a third-level Argentine center, in the period between 2012-2022. Only patients with pathology-confirmed gliomas, with 6-month follow-up, who had pre and postoperative volumetric MRI, were included in this sample. Subsequently, we analyzed which patients received surgery with the tMRI protocol and the results using multivariate regression analysis.

Results: A total of 71 patients were included. A tMRI study was performed on 22 (31%) of these patients. The use of tMRI increased the percentage of resection by 20% (p = 0.03), thereby increasing the possibility of gross-total resection. However, using tMRI significantly extended surgical time by 84 minutes (p < 0.001). In 55% of the patients in whom tMRI was performed, the resection was continued after it. The use of tMRI did not increase the rate of infections or the development of surgically associated neurological deficits in the long term, despite the fact that 47% of the patients showed the development of a new deficit or worsening of a previous one during the intraoperative period.

Conclusion: The use of tMRI in awake glioma surgery proved to be a safe tool that contributes to increasing the degree of tumor resection, compared to the use of neurophysiological mapping and neuronavigation, at the expense of increased surgical times and costs. We consider tMRI in awake glioma surgery should be used in properly selected cases.