{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:07:21Z","timestamp":1779527241998,"version":"3.53.1"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,3]]},"abstract":"\n OBJECTIVE<\/jats:title>\n In this analysis, the authors sought to identify variables triggering an additional resection (AR) and determining residual intraoperative tumor volume in 1.5-T intraoperative MRI (iMRI)-guided glioma resections.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A consecutive case series of 224 supratentorial glioma resections (WHO Grades I\u2013IV) from a prospective iMRI registry (inclusion dates January 2011\u2013April 2013) was examined with univariate and multiple regression models including volumetric data, tumor-related, and surgeon-related factors. The surgeon's expectation of an AR, in response to a questionnaire completed prior to iMRI, was evaluated using contingency analysis. A machine-learning prediction model was applied to consider if anticipation of intraoperative findings permits preoperative identification of ideal iMRI cases.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n An AR was performed in 70% of cases after iMRI, but did not translate into an accumulated risk for neurological morbidity after surgery (p = 0.77 for deficits in cases with AR vs no AR). New severe persistent deficits occurred in 6.7% of patients. Initial tumor volume determined frequency of ARs and was independently correlated with larger tumor remnants delineated on iMRI (p < 0.0001). Larger iMRI volume was further associated with eloquent location (p = 0.010) and recurrent tumors (p < 0.0001), and with WHO grade (p = 0.0113). Greater surgical experience had no significant influence on the course of surgery. The surgeon's capability of ruling out an AR prior to iMRI turned out to incorporate guesswork (negative predictive value 43.6%). In a prediction model, AR could only be anticipated with 65% accuracy after integration of confounding variables.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Routine use of iMRI in glioma surgery is a safe and reliable method for resection guidance and is characterized by frequent ARs after scanning. Tumor-related factors were identified that influenced the course of surgery and intraoperative decision-making, and iMRI had a common value for surgeons of all experience levels. Commonly, the subjective intraoperative impression of the extent of resection had to be revised after iMRI review, which underscores the manifold potential of iMRI guidance. In combination with the failure to identify ideal iMRI cases preoperatively, this study supports a generous, tumor-oriented rather than surgeon-oriented indication for iMRI in glioma surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.11.focus15542","type":"journal-article","created":{"date-parts":[[2016,3,1]],"date-time":"2016-03-01T03:37:27Z","timestamp":1456803447000},"page":"E4","source":"Crossref","is-referenced-by-count":32,"title":["Factors triggering an additional resection and determining residual tumor volume on intraoperative MRI: analysis from a prospective single-center registry of supratentorial gliomas"],"prefix":"10.3171","volume":"40","author":[{"given":"Moritz","family":"Scherer","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Jungk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Younsi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Kickingereder","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Heidelberg University Hospital, Heidelberg; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Technology Transfer Initiative, University of Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Unterberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15542","series-title":"Neurosurgery","first-page":"45","article-title":"Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis","volume":"34","author":"Albert","year":"1994"},{"key":"b2-focus15542","series-title":"Neurosurgery","first-page":"731","article-title":"Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection","volume":"48","author":"Bohinski","year":"2001"},{"key":"b3-focus15542","series-title":"Neurosurgery","article-title":"Low-grade glioma surgery in intraoperative MRI: Results of a multi-center retrospective assessment","author":"Coburger","year":"2015"},{"key":"b4-focus15542","series-title":"Neurosurgery","first-page":"1073","article-title":"Impact of intraoperative high-field magnetic resonance imaging guidance on glioma surgery: a prospective volumetric analysis","volume":"64","author":"Hatiboglu","year":"2009"},{"key":"b5-focus15542","series-title":"Curr Treat Options Neurol","first-page":"284","article-title":"Role of surgical resection in low- and high-grade gliomas","volume":"16","author":"Hervey-Jumper","year":"2014"},{"key":"b6-focus15542","series-title":"Ann Oncol","first-page":"3117","article-title":"Gross total but not incomplete resection of glioblastoma prolongs survival in the era of radiochemotherapy","volume":"24","author":"Kreth","year":"2013"},{"key":"b7-focus15542","series-title":"Neurosurgery","first-page":"852","article-title":"Quantification of glioma removal by intraoperative high-field magnetic resonance imaging: an update","volume":"69","author":"Kuhnt","year":"2011"},{"key":"b8-focus15542","series-title":"World Neurosurg","first-page":"770","article-title":"Intraoperative magnetic resonance imaging for resection of intra-axial brain lesions. A decade of experience using low-field magnetic resonance imaging, Polestar N-10, 20, 30 systems","volume":"82","author":"Livne","year":"2014"},{"key":"b9-focus15542","series-title":"J Neurosurg","first-page":"156","article-title":"Independent association of extent of resection with survival in patients with malignant brain astrocytoma","volume":"110","author":"McGirt","year":"2009"},{"key":"b10-focus15542","series-title":"Neurosurgery","first-page":"358","article-title":"Volumetric assessment of glioma removal by intraoperative high-field magnetic resonance imaging","volume":"55","author":"Nimsky","year":"2004"},{"key":"b11-focus15542","series-title":"J Neurosurg","first-page":"846","article-title":"An extent of resection threshold for recurrent glioblastoma and its risk for neurological morbidity","volume":"120","author":"Oppenlander","year":"2014"},{"key":"b12-focus15542","series-title":"J Neurosurg","first-page":"851","article-title":"Extent of resection in patients with glioblastoma: limiting factors, perception of resectability, and effect on survival","volume":"117","author":"Orringer","year":"2012"},{"issue":"1","key":"b13-focus15542","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Functional preoperative and intraoperative mapping and monitoring: increasing safety and efficacy in glioma surgery","volume":"38","author":"Ottenhausen","year":"2015"},{"key":"b14-focus15542","series-title":"World Neurosurg","first-page":"547","article-title":"Awake craniotomy, electrophysiologic mapping, and tumor resection with high-field intraoperative MRI","volume":"73","author":"Parney","year":"2010"},{"key":"b15-focus15542","series-title":"J Neurosurg","first-page":"3","article-title":"An extent of resection threshold for newly diagnosed glioblastomas","volume":"115","author":"Sanai","year":"2011"},{"key":"b16-focus15542","series-title":"Lancet Oncol","first-page":"997","article-title":"Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial","volume":"12","author":"Senft","year":"2011"},{"key":"b17-focus15542","series-title":"J Clin Oncol","first-page":"1338","article-title":"Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas","volume":"26","author":"Smith","year":"2008"},{"key":"b18-focus15542","series-title":"Neurosurgery","first-page":"564","article-title":"Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias","volume":"62","author":"Stummer","year":"2008"},{"key":"b19-focus15542","series-title":"Radiology","first-page":"506","article-title":"Supratentorial low-grade glioma resectability: statistical predictive analysis based on anatomic MR features and tumor characteristics","volume":"239","author":"Talos","year":"2006"},{"key":"b20-focus15542","series-title":"Comput Aided Surg","first-page":"172","article-title":"Intraoperative magnetic resonance imaging to update interactive navigation in neurosurgery: method and preliminary experience","volume":"2","author":"Wirtz","year":"1997"},{"issue":"Suppl 1","key":"b21-focus15542","series-title":"Neurosurgery","first-page":"145","article-title":"3.0-T intraoperative magnetic resonance imaging-guided resection in cerebral glioma surgery: interim analysis of a prospective, randomized, triple-blind, parallel-controlled trial","volume":"61","author":"Wu","year":"2014"},{"key":"b1-focus15542","series-title":"Neurosurgery","first-page":"45","article-title":"Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis","volume":"34","author":"Albert","year":"1994"},{"key":"b2-focus15542","series-title":"Neurosurgery","first-page":"731","article-title":"Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection","volume":"48","author":"Bohinski","year":"2001"},{"key":"b3-focus15542","series-title":"Neurosurgery","article-title":"Low-grade glioma surgery in intraoperative MRI: Results of a multi-center retrospective assessment","author":"Coburger","year":"2015"},{"key":"b4-focus15542","series-title":"Neurosurgery","first-page":"1073","article-title":"Impact of intraoperative high-field magnetic resonance imaging guidance on glioma surgery: a prospective volumetric analysis","volume":"64","author":"Hatiboglu","year":"2009"},{"key":"b5-focus15542","series-title":"Curr Treat Options Neurol","first-page":"284","article-title":"Role of surgical resection in low- and high-grade gliomas","volume":"16","author":"Hervey-Jumper","year":"2014"},{"key":"b6-focus15542","series-title":"Ann Oncol","first-page":"3117","article-title":"Gross total but not incomplete resection of glioblastoma prolongs survival in the era of radiochemotherapy","volume":"24","author":"Kreth","year":"2013"},{"key":"b7-focus15542","series-title":"Neurosurgery","first-page":"852","article-title":"Quantification of glioma removal by intraoperative high-field magnetic resonance imaging: an update","volume":"69","author":"Kuhnt","year":"2011"},{"key":"b8-focus15542","series-title":"World Neurosurg","first-page":"770","article-title":"Intraoperative magnetic resonance imaging for resection of intra-axial brain lesions. A decade of experience using low-field magnetic resonance imaging, Polestar N-10, 20, 30 systems","volume":"82","author":"Livne","year":"2014"},{"key":"b9-focus15542","series-title":"J Neurosurg","first-page":"156","article-title":"Independent association of extent of resection with survival in patients with malignant brain astrocytoma","volume":"110","author":"McGirt","year":"2009"},{"key":"b10-focus15542","series-title":"Neurosurgery","first-page":"358","article-title":"Volumetric assessment of glioma removal by intraoperative high-field magnetic resonance imaging","volume":"55","author":"Nimsky","year":"2004"},{"key":"b11-focus15542","series-title":"J Neurosurg","first-page":"846","article-title":"An extent of resection threshold for recurrent glioblastoma and its risk for neurological morbidity","volume":"120","author":"Oppenlander","year":"2014"},{"key":"b12-focus15542","series-title":"J Neurosurg","first-page":"851","article-title":"Extent of resection in patients with glioblastoma: limiting factors, perception of resectability, and effect on survival","volume":"117","author":"Orringer","year":"2012"},{"issue":"1","key":"b13-focus15542","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Functional preoperative and intraoperative mapping and monitoring: increasing safety and efficacy in glioma surgery","volume":"38","author":"Ottenhausen","year":"2015"},{"key":"b14-focus15542","series-title":"World Neurosurg","first-page":"547","article-title":"Awake craniotomy, electrophysiologic mapping, and tumor resection with high-field intraoperative MRI","volume":"73","author":"Parney","year":"2010"},{"key":"b15-focus15542","series-title":"J Neurosurg","first-page":"3","article-title":"An extent of resection threshold for newly diagnosed glioblastomas","volume":"115","author":"Sanai","year":"2011"},{"key":"b16-focus15542","series-title":"Lancet Oncol","first-page":"997","article-title":"Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial","volume":"12","author":"Senft","year":"2011"},{"key":"b17-focus15542","series-title":"J Clin Oncol","first-page":"1338","article-title":"Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas","volume":"26","author":"Smith","year":"2008"},{"key":"b18-focus15542","series-title":"Neurosurgery","first-page":"564","article-title":"Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias","volume":"62","author":"Stummer","year":"2008"},{"key":"b19-focus15542","series-title":"Radiology","first-page":"506","article-title":"Supratentorial low-grade glioma resectability: statistical predictive analysis based on anatomic MR features and tumor characteristics","volume":"239","author":"Talos","year":"2006"},{"key":"b20-focus15542","series-title":"Comput Aided Surg","first-page":"172","article-title":"Intraoperative magnetic resonance imaging to update interactive navigation in neurosurgery: method and preliminary experience","volume":"2","author":"Wirtz","year":"1997"},{"issue":"Suppl 1","key":"b21-focus15542","series-title":"Neurosurgery","first-page":"145","article-title":"3.0-T intraoperative magnetic resonance imaging-guided resection in cerebral glioma surgery: interim analysis of a prospective, randomized, triple-blind, parallel-controlled trial","volume":"61","author":"Wu","year":"2014"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/40\/3\/article-pE4.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/40\/3\/article-pE4.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/40\/3\/article-pE4.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T08:31:22Z","timestamp":1779525082000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/40\/3\/article-pE4.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,3]]},"references-count":42,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2015.11.focus15542","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,3]]}}}