When using preoperative tractography intraoperatively, inaccuracies due to brain shift might occur. Intraoperative tractography is rarely performed. Elastic fusion (EF) is a tool developed to compensate for brain shift, gravity, and tissue resection based on intraoperative images. Our hypothesis was that preoperative tractography is accurate and adjustments of tractography by intraoperative magnetic resonance imaging (ioMRI)-based EF (IBEF) compensate for brain shift. Between February 2018 and June 2019, 78 patients underwent eloquent (46 motor, 32 language) glioma resection in our department using intraoperative MRI. Mean distances between the resection cavity and tractography were analyzed and correlated with clinical outcomes. The mean ± standard deviation (range) distance after the application of IBEF was 5.0 ± 2.9 mm (0–10 mm) in patients without surgery-related motor deficits compared with 1.1 ± 1.6 mm (0–5 mm) in patients who showed new permanent surgery-related motor deficits postoperatively (p < 0.001). For language, the distance was 0.7 ± 1.2 mm (0–2 mm) in patients with new permanent deficits compared with 3.1 ± 4.5 mm (0–14 mm) in patients without new permanent surgery-related language deficits (p = 0.541). Preoperative tractography corrected by IBEF for subcortical resection of gliomas is highly accurate. However, at least for such subcortical anatomy, the severity of brain shift was considerably overestimated in the past.

Intraoperative magnetic resonance imaging (ioMRI) aims to improve gross total resection (GTR) in glioblastoma (GBM) patients. Despite some older randomized data on safety and feasibility, ioMRI’s actual impact in a modern neurosurgical setting utilizing a larger armamentarium of techniques has not been sufficiently investigated to date. We therefore aimed to analyze its effects on residual tumor, patient outcome, and progression-free survival (PFS) in GBM patients in a modern high-volume center. Patients undergoing ioMRI for resection of supratentorial GBM were enrolled between March 2018 and June 2020. ioMRI was performed in all cases at the end of resection when surgeons expected complete macroscopic tumor removal. Extent of resection (EOR) was performed by volumetric analysis, with GTR defined as an EOR ≥ 95%, respectively. Progression-free survival (PFS) was analyzed through univariate and multivariate Cox proportional regression analyses. In total, we enrolled 172 patients. Mean EOR increased from 93.9% to 98.3% (p < 0.0001) due to ioMRI, equaling an increase in GTR rates from 78.5% to 93.0% (p = 0.0002). Residual tumor volume decreased from 1.3 ± 4.2 cm³ to 0.6 ± 2.5 cm³ (p = 0.0037). Logistic regression revealed recurrent GBM as a risk factor leading to subtotal resection (STR) (odds ratio (OR) = 3.047, 95% confidence interval (CI) 1.165–7.974, p = 0.023). Additional resection after ioMRI led to equally long PFS compared to patients with complete tumor removal before ioMRI (hazard ratio (HR) = 0.898, 95%-CI 0.543–1.483, p = 0.67). ioMRI considerably reduces residual tumor volume and helps to achieve comparable PFS, even in patients with unexpected residual tumor after initial resection before ioMRI.

Objective: Atypical teratoid rhabdoid tumor (ATRT) is a rare pediatric brain tumor characterized by an extremely poor prognosis despite receiving comprehensive treatments. Circulating tumor cells (CTCs) detection has high clinical value in the prediction of the progression of malignant solid tumors and the evaluation of treatment effects. However, very few studies have focused on CTCs in pediatric CNS embryonal tumors especially ATRT. This study aims to evaluate and compare the feasibility of detecting CTCs in young children with ATRT, and to analyze the clinical value of CTCs count in monitoring ATRT tumor progression. Methods: Young children under 3 years old who were diagnosed with ATRT and performed maintenance treatment from July 2023 to June 2024 after comprehensive therapy in our institution were enrolled. CTCs count both in cerebrospinal fluid (CSF) and peripheral blood were separately calculated based on two morphological types: CTC and tumor-derived circulating hybrid cells (CHC). Area under the receiver operating characteristic (ROC) curves (AUC) were used to determine the threshold of CTCs in predicting tumor progression. Kappa coefficients were applied to assess consistency between MRI scans, CSF cytology and CTCs by using progressive disease (PD) outcomes as the reference. Results: CTCs count in 34 blood samples and 34 CSF samples, as well as the results of CSF cytology examination and MRI scans in simultaneous period, were collected from six pediatric patients. When the progressive disease (PD) outcomes were used as a reference, CSF cytology test had a higher false negative rate compared with MRI scans (37.5% vs. 8.3%). In CSF, the sum of CTC + CHC had the highest significant diagnostic efficacy (AUC = 0.771, p = 0.001, Accuracy = 73.5%) with a cut-off value of 2.5. All of CSF-CTCs had statistically significant consistency with PD outcomes. In peripheral blood, all of CTCs had insignificant diagnostic efficacy. However, the sum of CTC + CHC had statistically significant consistency with PD outcomes (Kappa value = 0.406, p = 0.024), with a negative prediction cut-off value of 65 (AUC = 0.397, p = 0.371, Accuracy = 76.5%). Conclusion: CTCs in CSF and peripheral blood can both be detected in young-age ATRT patients after receiving comprehensive treatment. CTCs have considerable clinical predictive value in monitoring the progression of ATRT.