- Department of Neurosurgery, Maastricht University Medical Center, The Netherlands
Pieter L. Kubben
Department of Neurosurgery, Maastricht University Medical Center, The Netherlands
DOI:10.4103/2152-7806.106114Copyright: © 2013 Kubben PL This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Kubben PL, Santbrink Hv. Intraoperative magnetic resonance imaging for high grade glioma resection: Evidence-based or wishful thinking?. Surg Neurol Int 15-Jan-2013;4:1
How to cite this URL: Kubben PL, Santbrink Hv. Intraoperative magnetic resonance imaging for high grade glioma resection: Evidence-based or wishful thinking?. Surg Neurol Int 15-Jan-2013;4:1. Available from: http://sni.wpengine.com/surgicalint_articles/intraoperative-magnetic-resonance-imaging-for-high-grade-glioma-resection-evidence-based-or-wishful-thinking/
In their review, Liang and Schulder provide an update on the role of intraoperative magnetic resonance imaging (iMRI) in gliomas.[
First, we all know that gliomas in general, and high grade gliomas in particular, are a generalized disease of the brain instead of a localized process. This means that surgery can never be curative, and the (relative) merit of increased extent of tumor resection (EOTR) needs to be seen in this context. Still, if increased EOTR is associated with prolonged survival,[
To continue, we do not have a valid endpoint for postoperative tumor volume. Interobserver agreement has been demonstrated to be unacceptably low in a pilot study on this topic,[
Another consideration is workflow integration, which is partially related to cost. iMRI guided surgery takes significantly more time, and can more or less interfere with the surgical workflow (e.g., compatibility of instruments or equipment) depending on the sort of iMRI technology used.
To conclude, despite class I evidence that iMRI guided surgery of high grade gliomas leads to increased EOTR, the clinical advantage is much less clear, and is limited by the nature of gliomas in itself. If we add the lack of a valid volumetric endpoint, and other modalities that offer comparable effectiveness for much less cost (like 5-ALA), then it becomes more understandable why iMRI seems to be losing interest in the international community.
In our opinion, narrative reviews on iMRI ornated with literature references but without a critical reflection, do not deserve a place in modern neurosurgical literature anymore, and the article's conclusion[
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