The real impact of Intraoperative MRI in newly diagnosed Glioblastoma Multiforme Resection. An observational analytic cohort study from a single surgeon experience

Background: The goal of surgery for brain glioma is to maximize the extent of tumor resection, avoiding postoperative functional impairment. Intraoperative (Io) magnetic resonance imaging (MRI) has emerged as an effective tool to guide a safer glioma resection. The objective of this study is to assess the real impact of Io MRI in O-6-methylguanine-DNA methyltransferase and non-O-6-methylguanine-DNA methyltransferase methylated glioma surgery. Methods: A total of 129 patients suffering glioblastoma who underwent craniotomy for tumor resection were retrospectively evaluated between March 2009 and January 2017 at 2 different affiliated hospitals of the same university. We compared a subgroup of 65 patients operated on without Io MRI (group A) with a second subgroup of 64 patients who underwent surgery with the aid of Io MRI (group B). Volumetric analyses of the extent of resection (EOR) were performed using gadolinium-enhanced T1-weighted imaging. All surgical procedures were performed by a single surgeon (the senior author). Results: The average EOR increased from 86.23% ± 10.51% for group A to 94.01% ± 7.42% in patients included in group B. The secondary end points of this study were progression-free survival (PFS) and overall survival (OS). PFS was found to be 5.38 ± 2.32 months for group A versus 7.89 ± 2.75 months for group B. Regarding OS, the average value was 13.38 ± 4.06 months for group A versus 16.43 ± 3.41 months for group B. Conclusions: We can affirm that 1.5-T Io MRI is a safe and effective technique, and its use optimizes significantly both the extent of glioma resection and the survival of patients.