Comparison of Standard Neuronavigation With Intraoperative Magnetic Resonance Imaging (MRI) for the Neurosurgical Treatment of Malignant Brain Tumors

Randomized Assessment of Conventional Neuronavigation Versus Intraoperative MRI for the Neurosurgical Treatment of Glioblastomas

The treatment of a specific subtype of highly malignant brain tumor (called "glioblastoma" or "glioblastoma multiforme") consists of neurosurgical resection, followed by radiotherapy and mostly chemotherapy as well. Increased extent of tumor resection is associated with prolonged survival. The standard treatment uses conventional neuronavigation systems to increase extent of tumor resection. However, the quality of this form of neuronavigation decreases throughout surgery because of "brain shift". This is caused by edema, loss of cerebrospinal fluid and tumor resection. A new form of neuronavigation uses intraoperative MRI to compensate for brain shift, and to check for the presence of residual tumor that can be removed.

This study aims to compare the extent of glioblastoma resection between the standard treatment and intraoperative MRI.

Inclusion Criteria:

• supratentorial brain tumor, on contrast enhanced dMRI suspected to be GBM
• indication for gross total resection (GTR) of the tumor
• age ≥18 years
• WHO Performance Scale ≤ 2
• ASA class ≤ 3
• adequate knowledge of the Dutch or French language
• informed consent

Exclusion Criteria:

• recurrent brain tumor
• multiple brain tumor localizations
• earlier skull radiotherapy
• earlier chemotherapy for GBM
• Chronic Kidney Disease or other renal function disorder
• known MR-contrast allergy