Abstract SNACC-101

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Introperative MRI and its effect on outcome in patients undergoing intracranial tumor surgery: A retrospective study.

1Tewari A, 1Chakrabarti R R, 2Mohammadi A, 1Avitsian R
1Cleveland Clinic Foundation, Cleveland, Ohio, USA; 2Clelevand Clinic Foundation, Cleveland, Ohio, USA

Background: Intraoperative MRI is gaining popularity as a result of its effect on early detection of complete or near complete tumor excision. We report the 30 day outcome after craniotomy for intracranial tumor excision in an intraoperative MRI (iMRI) setting. Most of the studies so far are related to iMRI surgery and not on anesthetic implication and patient outcome has been looked into in detail.
Methods: Retrospective chart review and analysis of an existing database from electronic patient records and paper charts of patient who underwent iMRIS was carried out. We examined the 30 day outcome of patients who were operated in the last three years. The following endpoints determined the patient outcome: location of patient on the 30th day (Home/ward/ICU/Hospice/dead), 30 day mortality rate, length of post-operative High dependency unit (HDU) or Intensive Care Unit (ICU) stay, re-admission rate and need for repeat surgery within 30 days, clinically observable Neurological deficit, Karnofsky performance score (KPS) within the first months after surgery and neurological improvement at the 30th post op day.
Results: From a total of 133 patient who underwent iMRIS in the last three years, medical records of 112 patients were reviewed. There were 48 males and 64 females with an average age of 46.7 . The distribution for the location of the patients on the 30th day after surgery was home (84%), rehabilitation center (10%) and ICU (6%). There were no mortalities within the study periods though 12% expired after the 30 days. The average length of stay in HDU/ICU was 2.4 days. Only 3% patients had repeat surgeries within the 30 days for minor surgeries (wound infection, drain removal etc). The average Karnofsky performance score was 80 on the 30th day postoperatively. The average surgical time was 271.6 minutes while the anesthesia time was 353.5 minutes. Immediate postoperative anesthesia complications comprised of PONV (7.3%), Pain (3.2%) and delayed emergence (1.5%). All patients were shifted to post anesthesia care unit (PACU) and then to lower dependency units. Surgical complications were very minor and comprised transitory speech and movement disorders, wound infections, subgaleal fluid collection, and hydrocephalus.
Discussion: Currently we are reporting the 30 day outcome after craniotomy for intracranial tumors in an iMRIS setting. We invite investigators to add their experience to our findings for comparison. We also plan to compare these results with those being performed in a non-iMRI setting although we believe the results may suggest patients undergoing iMRIS had fewer surgical complications and re-operations within the stipulated study period we need more data collection and statistical comparison to confirm our hypothesis. The anesthetic time however does increase secondary to a cumbersome and prolonged patient preparation and MRI scan time.
1. Claus EB, Horlacher A, Hsu L, Schwartz RB, Dello-Iacono D, Talos F, Jolesz FA, Black PM (2005). Cancer 103:1227–1233
2. De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS (2012). J Clin Oncol 30(20):2559–2565

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