Frameless stereotactic surgery using intraoperative high-field magnetic resonance imaging

Area of Science:

• Neurosurgery
• Medical Imaging
• Stereotactic Surgery

Background:

• Frameless stereotaxy is a neurosurgical technique for precise instrument guidance.
• Intraoperative magnetic resonance (iMR) imaging provides real-time anatomical visualization.
• Combining these technologies may enhance surgical accuracy and patient outcomes.

Purpose of the Study:

• To evaluate the clinical validity of frameless stereotaxy augmented by high-field intraoperative magnetic resonance (iMR) imaging.
• To assess the accuracy and efficacy of this combined approach for brain biopsies and catheter placements.

Main Methods:

• 32 procedures (19 biopsies, 13 catheter placements) using a 1.5 Tesla MR scanner and neuronavigation system.
• Evaluation based on histological diagnostic yield and accurate catheter placement.
• Registration error measured at 1.2 +/- 0.8 mm; iMR imaging used for confirmation and repositioning.

Main Results:

• Successful instrument placement in target tissue for all biopsies and catheter placements.
• All biopsy samples confirmed as pathological via frozen section and iMR imaging.
• Catheter repositioning in 4/13 cases based on iMR imaging improved placement success.
• No procedure-related neurological deficits or mortality; two wound infections occurred.

Conclusions:

• The combination of frameless stereotaxy and high-field iMR imaging enhances surgical precision for neurosurgical procedures.
• This integrated technique demonstrates low morbidity and mortality.
• While improving quality, the addition of iMR imaging did not significantly reduce overall procedure time.