Functional neuronavigation and intraoperative MRI

Our concept of computer assisted surgery is based on the combination of intraoperative magnetic resonance (MR) imaging with microscope-based neuronavigation, providing anatomical and functional guidance simultaneously. Intraoperative imaging evaluates the extent of a resection, while the additional use of functional neuronavigation, which displays the position of eloquent brain areas in the operative field, prevents increasing neurological deficits, which would otherwise result from extended resections. Up to mid 2001 we performed intraoperative MR imaging using a low-field 0.2 Tesla scanner in 330 patients. The main indications were the evaluation of the extent of resection in gliomas, pituitary tumours, and in epilepsy surgery. Intraoperative MR imaging proved to serve as intraoperative quality control with the possibility of an immediate modification of the surgical strategy, i.e. extension of the resection. Integrated use of functional neuronavigation prevented increased neurological deficits. Compared to routine pre- or postoperative imaging being performed with high-Tesla machines, intraoperative image quality and sequence spectrum could not compete. This led to the development of the concept to adapt a high-field MR scanner to the operating environment, preserving the benefits of using standard microsurgical equipment and microscope-based neuronavigational guidance with integrated functional data, which was successfully implemented by April 2002. Up to the end of 2002, 95 patients were investigated with the new setup. Improved image quality, intraoperative workflow, as well as enhanced sophisticated intraoperative imaging possibilities are the major benefits of the high-field setup.