Intraoperative magnetic resonance imaging (iMRI) has witnessed significant growth in the field of neurosurgery, particularly in glioma surgery, enhancing image-guided neuronavigation and optimizing the extent of resection (EOR). Despite its extensive use in the treatment of gliomas, its utility in brain metastases (BMs) remains unexplored. This study examined the effect of iMRI on BM resection. This retrospective study was conducted at the neurosurgical center of the University Hospital of the Technical University of Munich and involved 25 patients with BM who underwent resection using 3-Tesla iMRI between 2018 and 2022. Volumetric measurements of the resected contrast-enhancing metastases were performed using preoperative, intraoperative, and postoperative MRI images. The Karnofsky Performance Score (KPS) and neurological status of the patients were assessed pre- and postoperatively. Local recurrence and in-brain progression were reported in patients who underwent follow-up MRI at 3 and 6 months postoperatively. In this cohort (n= 25, mean age 63.6 years), non-small-cell lung cancer (NSCLC) was the most common origin (28%). The mean surgical duration was 219.9 min, and that of iMRI was 61.7 min. Indications for iMRI were primarily associated with preoperative imaging, suggesting an unclear entity that is often suspicious for glioma. Gross total resection (GTR) was achieved in 21 patients (84%). Continued resection was pursued after iMRI in six cases (24%), resulting in an improved EOR of 100% in five cases and 97.6% in one case. Neurological status postoperatively remained stable in 60%, improved in 24%, and worsened in 16% of patients. No wound healing or postoperative complications were observed. Among the thirteen patients who underwent follow-up MRI 3 months postoperatively, one patient showed local recurrence at the site of resection, and seven patients showed in-brain progression. Of the eight patients who underwent a 6-month follow-up MRI, two showed local recurrence, while three exhibited in-brain progression. The observed favorable profiles of GTR, coupled with the notable absence of wound-healing problems and acute postoperative complications, affirm the safety and feasibility of incorporating iMRI into the neurosurgical workflow for resecting BM with specific indications. The real-time imaging capabilities of iMRI offer unparalleled precision, aiding meticulous tumor delineation and informed decision-making, ultimately contributing to improved patient outcomes. Although our experience suggests the potential benefits of iMRI as a safe tool for enhancing EOR, we acknowledge the need for larger prospective clinical trials. Comprehensive investigations on a broader scale are imperative to further elucidate the specific indications for iMRI in the context of BMs and to study its impact on survival. Rigorous prospective studies will refine our understanding of the clinical scenarios in which iMRI can maximize its impact, guiding neurosurgeons toward more informed and tailored decision-making.
术中磁共振成像（iMRI）在神经外科领域，尤其是胶质瘤手术中应用显著增长，其通过增强图像引导的神经导航优化了肿瘤切除范围（EOR）。尽管iMRI已广泛应用于胶质瘤治疗，但其在脑转移瘤（BMs）中的应用价值尚未明确。本研究探讨了iMRI对脑转移瘤切除的影响。这项回顾性研究在慕尼黑工业大学大学医院神经外科中心开展，纳入了2018年至2022年间接受3特斯拉iMRI辅助切除手术的25例脑转移瘤患者。通过术前、术中和术后MRI图像对切除的对比增强转移瘤进行体积测量。术前术后评估患者卡氏功能状态评分（KPS）及神经功能状态。对术后3个月和6个月接受随访MRI检查的患者报告局部复发和颅内进展情况。在本队列（n=25，平均年龄63.6岁）中，非小细胞肺癌（NSCLC）是最常见的原发癌类型（28%）。平均手术时长为219.9分钟，iMRI操作时长为61.7分钟。iMRI的应用指征主要与术前影像学表现相关，常因疑似胶质瘤而存在诊断不明确的情况。21例患者（84%）实现肉眼全切（GTR）。6例患者（24%）在iMRI引导下进行扩大切除，其中5例EOR提升至100%，1例提升至97.6%。术后神经功能状态保持稳定者占60%，改善者24%，恶化者16%。未观察到伤口愈合问题或术后并发症。在术后3个月接受随访MRI的13例患者中，1例出现切除部位局部复发，7例出现颅内进展。在术后6个月接受随访MRI的8例患者中，2例出现局部复发，3例出现颅内进展。观察到的较高肉眼全切率，以及显著无伤口愈合问题和急性术后并发症的情况，证实了将iMRI整合到具有特定指征的脑转移瘤神经外科手术流程中的安全性和可行性。iMRI的实时成像能力提供了无与伦比的精确性，有助于精细勾画肿瘤边界并支持临床决策，最终改善患者预后。尽管我们的经验表明iMRI作为提高切除范围的安全工具具有潜在优势，但我们认识到仍需开展更大规模的前瞻性临床试验。必须开展更广泛的全面研究，以进一步阐明iMRI在脑转移瘤治疗中的具体适应症，并研究其对生存期的影响。严格的前瞻性研究将深化我们对iMRI能最大化发挥作用的临床场景的理解，指导神经外科医生做出更明智和个体化的决策。
肿瘤(癌症)患者之家