Impact and effectiveness of ioMRI and awake surgery in glioma surgery

Abstract

Despite all ours "technological bubbles", surgical removal of infiltrating brain tumours remains limited to 65%-76% in the recent large series published in the Literature. Fuzzy tumour/brain margins are the main cause of failure in reaching "complete" removals. Aggressive attempts at "supramarginal" resection often carry a risk of functional cortical and subcortical structures' damage with an unacceptable decrease in quality of life and post-operative functional status and an increase in post-operative psychological, human and financial costs for the patient, his/her carers and the NHS.Awake surgery and ioMRI (intra-operative MRI) proved to be the most effective individual aids in preventing damage to functional brain while maximizing the extent of resection.We present our series of 22 patients operated on at Southmead Hospital (North Brstol NHS Trust) in between July 2014 and Dec 2016 using both ioMRI and awake surgery (MAC, monitored anaesthesia care). Setting, patients' features, indications, type and size of tumours, and surgical times will be analysed and discussed.Using ioMRI together with awake surgery is demanding for the anaesthetic team, stuff nurse and for the patient. Theatre times are about 2 hours longer than the standard awakes, with an average stay of 10 hours. Nevertheless, post-operative patient's satisfaction together with very low morbidity and higher total resections rates (well above the average of the current published data) wipe the aforementioned concerns about ioMRI+awake feasibility in challenging neuro-oncology cases.