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Low-field magnetic resonance imaging for intraoperative use in neurosurgery: a 5-year experience
Christopher Nimsky1, Oliver Ganslandt, Bernd Tomandl
1Department of Neurosurgery, University Erlangen-Nuremberg, 91054 Erlangen, Germany. nimsky@nch.imed.uni-erlangen.de
Abstract:
The aim of this study was to evaluate the feasibility and point out the indications of intraoperative MR imaging in neurosurgical procedures. The MR imaging was performed using a 0.2-T scanner which was located in a radiofrequency-shielded operating theater. Three major setups for intraoperative imaging were possible: inside the scanner; at the 5-Gauss line; or in an adjacent operating theater. Additionally, in lesions adjacent to eloquent brain areas microscope- and pointer-based neuronavigation with integrated functional data was applied. Three hundred ten patients were investigated in the previous 5 years, among them gliomas ( n=95), pituitary tumors ( n=81), and 39 non-lesional cases in whom resective or disconnective epilepsy surgery was carried out. We did not observe any adverse effects due to intraoperative MR imaging. Image quality was sufficient to evaluate the extent of the tumor resection in the majority of cases. The main indications for intraoperative MR imaging were the evaluation of the extent of a resection in glioma, ventricular tumor, pituitary tumor, and in epilepsy surgery. Intraoperative MR imaging offers the possibility of further tumor removal during the same surgical procedure in case of tumor remnants, increasing the rate of complete tumor removal. Furthermore, the effects of brain shift, which would lead to inaccurate neuronavigation, can be compensated for by an update of the neuronavigation system with intraoperative MR image data.
Insights
Intraoperative MRI is feasible for neurosurgery, improving tumor resection rates. This imaging helps surgeons assess tumor removal and update navigation systems, compensating for brain shift.
Area of Science:
- Neurosurgery
- Medical Imaging
- Oncology
Background:
- This study assessed the feasibility and indications of intraoperative Magnetic Resonance (MR) imaging in neurosurgical procedures.
- A 0.2-Tesla MR scanner was utilized in a radiofrequency-shielded operating theater, with three possible imaging setups.
- Neuronavigation systems with integrated functional data were employed for lesions near eloquent brain areas.
Discussion:
- Intraoperative MR imaging was performed on 310 patients over five years, including those with gliomas, pituitary tumors, and epilepsy.
- No adverse effects were observed, and image quality was sufficient for assessing tumor resection extent in most cases.
- Key indications included evaluating resection extent for gliomas, ventricular tumors, pituitary tumors, and epilepsy surgery.
Key Insights:
- Intraoperative MR imaging enables further tumor removal during the same procedure by identifying remnants, thus increasing complete resection rates.
- Brain shift, which can compromise neuronavigation accuracy, can be effectively managed by updating navigation systems with intraoperative MR data.
- The integration of intraoperative MR imaging enhances surgical precision and patient outcomes in complex neurosurgical interventions.
Outlook:
- Further research could explore advanced MR techniques for real-time functional imaging during surgery.
- Standardization of intraoperative MR protocols may improve its adoption across various neurosurgical procedures.
- Investigating the long-term impact of intraoperative MR imaging on patient outcomes and recurrence rates is warranted.