Intraoperative magnetic resonance imaging for cerebral cavernous malformations: When is it maybe worth it? |
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| Institution: | 1. Department of Neurological Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain;2. Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain;3. Department of Neurological Surgery, Germans Trias i Pujol Hospital University Hospital, Barcelona, Spain;4. Department of Neurorradiology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain;5. Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain;1. Division of Pediatric Urology, Department of Urology, University of Arkansas for Medical Sciences, Arkansas Children''s Hospital, Little Rock, AR;2. Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Arkansas Children''s Hospital, Little Rock, AR;1. Department of Neurosurgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany;2. Department of Otorhinolaryngology – Head and Neck Surgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany |
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| Abstract: | ObjectiveIntraoperative magnetic resonance imaging (iMRI) can be useful for cerebral cavernous malformations (CCM) surgery. However, literature on this topic is scarce. We aim to investigate its clinical utility and propose criteria for the selection of patients who may benefit the most from iMRI.MethodsFrom 2017 to 2019, all patients with CCMs who required surgery assisted with iMRI were included in the study. Clinical and radiological features were analyzed. Outcome measures included the need for an immediate second-look resection and clinical course in early post-surgery -Timepoint 1- (Tp1) and at the 6-to-12-month follow-up -Timepoint2- (Tp2).ResultsOut of 19 patients with 20 CCMs, 89% had bleeding in the past, and in 75% the CCM affected an eloquent area. According to the iMRI results, an immediate second-look resection was needed in 16% of them. In one patient, a remnant was not seen on iMRI. The mRS worsened in the immediate post-surgical exam (median, 1; IQR, 1) with improvements on the 6-month visit (median, 1; IQR, 2), (p = 0.018). When comparing the outcome of patients with and without symptoms at baseline, the latter fared better at Tp2 (p = 0.005).ConclusionsiMRI is an intraoperative imaging tool that seems safe for CCM surgery and might reduce the risk of lesion remnants. In our series, it allowed additional revision for further resection in 16% of the patients. In our experience, iMRI may be especially useful for lesions in eloquent areas, those with a significant risk of brain shift and for large CCMs. |
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| Keywords: | Cavernous malformation Intraoperative MRI Cavernous remnants |
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