• Jan Coburger, Andreas Merkel, Moritz Scherer, Felix Schwartz, Florian Gessler, Constantin Roder, Andrej Pala, Ralph König, Lars Bullinger, Gabriele Nagel, Christine Jungk, Sotirios Bisdas, Arya Nabavi, Oliver Ganslandt, Volker Seifert, Marcos Tatagiba, Christian Senft, Maximilian Mehdorn, Andreas W Unterberg, Karl Rössler, and Christian Rainer Wirtz.
• ‡Department of Neurosurgery, University of Ulm, Günzburg, Germany; §Department of Neurosurgery, University of Erlangen, Erlangen, Germany; ¶Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany; ‖Department of Neurosurgery, University of Schleswig-Holstein, Kiel, Germany; #Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany; **Department of Neurosurgery, University of Tübingen, Tübingen, Germany; ‡‡Department of Internal Medicine III, University of Ulm, Ulm, Germany; §§Institute for Epidemiology and Medical Biometrics, University of Ulm, Ulm, Germany; ¶¶Department of Neuroradiology, University of Tübingen, Tübingen, Germany; ‖‖Department of Neurosurgery, International Neuroscience Institute Hannover, Hannover, Germany; ##Department of Neurosurgery, Klinikum Stuttgart, Stuttgart, Germany.
• Neurosurgery. 2016 Jun 1; 78 (6): 775-86.

BackgroundThe ideal treatment strategy for low-grade gliomas (LGGs) is a controversial topic. Additionally, only smaller single-center series dealing with the concept of intraoperative magnetic resonance imaging (iMRI) have been published.ObjectiveTo investigate determinants for patient outcome and progression-free-survival (PFS) after iMRI-guided surgery for LGGs in a multicenter retrospective study initiated by the German Study Group for Intraoperative Magnetic Resonance Imaging.MethodsA retrospective consecutive assessment of patients treated for LGGs (World Health Organization grade II) with iMRI-guided resection at 6 neurosurgical centers was performed. Eloquent location, extent of resection, first-line adjuvant treatment, neurophysiological monitoring, awake brain surgery, intraoperative ultrasound, and field-strength of iMRI were analyzed, as well as progression-free survival (PFS), new permanent neurological deficits, and complications. Multivariate binary logistic and Cox regression models were calculated to evaluate determinants of PFS, gross total resection (GTR), and adjuvant treatment.ResultsA total of 288 patients met the inclusion criteria. On multivariate analysis, GTR significantly increased PFS (hazard ratio, 0.44; P < .01), whereas "failed" GTR did not differ significantly from intended subtotal-resection. Combined radiochemotherapy as adjuvant therapy was a negative prognostic factor (hazard ratio: 2.84, P < .01). Field strength of iMRI was not associated with PFS. In the binary logistic regression model, use of high-field iMRI (odds ratio: 0.51, P < .01) was positively and eloquent location (odds ratio: 1.99, P < .01) was negatively associated with GTR. GTR was not associated with increased rates of new permanent neurological deficits.ConclusionGTR was an independent positive prognostic factor for PFS in LGG surgery. Patients with accidentally left tumor remnants showed a similar prognosis compared with patients harboring only partially resectable tumors. Use of high-field iMRI was significantly associated with GTR. However, the field strength of iMRI did not affect PFS.AbbreviationsEoR, extent of resectionFLAIR, fluid-attenuated inversion recoveryGTR, gross total resectionIDH1, isocitrate dehydrogenase 1iMRI, intraoperative magnetic resonance imagingLGG, low-grade gliomaMGMT, methylguanine-deoxyribonucleic acid methyltransferasenPND, new permanent neurological deficitOS, overall survivalPFS, progression-free survivalSTR, subtotal resectionWHO, World Health Organization.

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