Intraoperative MRI: technology, systems, and application to pediatric brain tumors

Intraoperative magnetic resonance imaging (MRI) is a revolutionary technology that provides real-time assessment of surgical goals for the neurosurgeon. This technology has rapidly evolved over the past 15 years and currently is used for a wide variety of pathologies. These include gliomas, pituitary adenomas, epileptogenic foci, and complex hydrocephalus. Early generations of similar systems were bulky, tedious, and had marginal image quality. The next generation of systems provided improved image quality, easier surgical access, the ability to incorporate advanced imaging modalities, and integrated neuronavigation. This chapter reviews the intraoperative MRI technology, the various systems currently available, and the application of this technology to pediatric brain tumors. Continued refinements in the design of these systems will likely make them standard of care in the near future.