Cancer Management and Research (Oct 2018)
An ioMRI-assisted case of cervical intramedullary diffuse glioma resection
Abstract
Zafer Orkun Toktas,1,2 Baran Yilmaz,1 Murat Şakir Ekşi,1,3 Lei Wang,2,4 Akin Akakin,1 Yasin Yener,5 Murat Konakcı,6 Emre Ayan,7 Turker Kılıc,1 Deniz Konya,1,2 Yang D Teng2,4 1Department of Neurosurgery, Bahçeşehir University Medical Faculty, Istanbul, Turkey; 2Departments of Physical Medicine and Rehabilitation and Neurosurgery, Harvard Medical School, Boston, MA, USA; 3Department of Orthopedic Surgery, University of California at San Francisco, San Francisco, CA, USA; 4Division of Spinal Cord Injury Research, Veterans Affairs Healthcare System, Boston, MA, USA; 5Department of Anesthesiology, Göztepe Medikal Park Hospital, Istanbul, Turkey; 6Department of Anesthesiology, Bahçeşehir University Medical Faculty, Istanbul, Turkey; 7Department of Radiology, Göztepe Medical Park, Istanbul, Turkey Purpose: To date, application of intraoperative magnetic resonance imaging (ioMRI) to enhance surgical quality for spinal intramedullary neoplastic lesions has been rarely reported. Moreover, in developing countries or regions, ioMRI accessibility remains very limited. This report describes a technology design of high-field ioMRI accessible for multioperation rooms via a case presentation of an imaging-assisted surgical excision of human cervical spinal cord diffuse glioma.Patient and methods: The patient was a 44-year-old woman with symptomatic and progressive C2–5 intramedullary diffuse glioma (IDG). Our ioMRI system was designed and arranged with accessibility to multiple operation rooms, which was used to assure more complete spinal cord or brain tumor removal. The intraoperational diagnostic aspects and the system setup technical details are presented for future applications of the system in hospitals where a designated ioMRI suite is not available.Results: After a conventionally defined complete removal of C2–C5 IDG using a well-established surgical approach, ioMRI examination was able to detect residual tumor tissues that were indistinguishable under the surgical microscope. The IDG clusters were subsequently excised. The operation regimen resulted in a gross total elimination of the tumor, which enabled the patient to show very satisfactory postsurgery recovery and prognosis.Conclusion: ioMRI-assisted surgical removal of cervical spinal cord diffuse glioma should be systematically developed and applied to enhance therapeutic efficacy. The reported logistic flow of operating room tasks and imaging technical management are innovative for performing the tumor removal procedures in hospitals where designated ioMRI surgical suites do not exist. Critically, we emphasize implementation of stringent quality control measures for patient transportation safety and contamination prevention in establishing and maintaining such a system. Keywords: intraoperative imaging, spine, spinal cord, glioma, residual tumor, decompression
