Glioblastoma, High Grade Glioma
Conditions
Brief summary
On regular (diagnostic) MRI images brain tumors can show contrast enhancement: uptake of an intravenously administered contrast agent can cause an enhancement pattern that is seen as a white area on a frequently used MRI protocol (T1 weighted imaging). High grade gliomas are a common brain tumor that share this enhancement pattern. The goal of surgery is to resect this contrast enhancing part without causing additional neurological damage. Intraoperative MRI (iMRI) is a helpful tool in achieving this goal, because it can provide updated images during resection and correct for deformations that occur in the brain during surgery. These deformations make preoperative images that are used for standard neuronavigation systems less reliable. However, due to manipulations during surgery, the contrast uptake during surgery may differ from contrast uptake in diagnostic MRI. This study aims to relate contrast enhancement on iMRI and tumor characteristics on tissue samples from the tumor. When the neurosurgeon considers the resection of the high grade glioma to be complete, an iMRI scan will be made, and tissue sampling will be performed on the borderzones of the tumor or tumor resection cavity respectively. This will provide insight in the relation between contrast enhancement on iMRI and the presence of tumor tissue. Such knowledge is important to improve effectiveness and safety of iMRI guided brain tumor resection.
Interventions
DEVICEPoleStar N20 intraoperative MRI
low field strength mobile intraoperative MRI system (0,15 Tesla) with local Faraday shielding (using the StarShield system)
Sponsors
Maastricht University Medical Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* supratentorial brain tumor, on contrast enhanced MRI suspect for a high grade glioma * indication for resection of the tumor * age ≥ 18 years * WHO Performance Scale ≤ 2 * ASA class ≤ 3 * good knowledge of the Dutch language * informed consent
Exclusion criteria
* recurrent tumor * multiple tumor localizations * prior radiotherapy on the skull * prior chemotherapy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The relation between the shape and size of contrast enhancement on intraoperative MRI at the resection cavity border, and the presence of residual tumor tissue. | after surgery, and after 1 year for additional immunochemistry |
Secondary
| Measure | Time frame |
|---|---|
| Survival (Kaplan Meier) | after 4 years |
| Postoperative clinical condition (WHO Performance Scale) | 1 week after surgery |
| The relation between possible contrast enhancement and contrast enhancing tissue volume on the last intraoperative MRI scan and the early diagnostic MRI scan | within 72 hours after surgery |
Countries
Netherlands
Outcome results
None listed