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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
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Neuroendoscopy and high-field intraoperative MRI: first experience
Andreas M Stark1, Felix Schwartz1, Maximilian Mehdorn1
1Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie/Neurosurgery, Kiel, Germany.
Summary
Intraoperative MRI (iMRI) integrated into neuroendoscopy offers high-resolution imaging for complex hydrocephalus cases. This technique is feasible and valuable for confirming procedures and detecting complications during surgery.
Area of Science:
- Neurosurgery
- Medical Imaging
- Endoscopic Procedures
Background:
- Information on intraoperative MRI (iMRI) use in neuroendoscopic procedures is limited.
- iMRI may enhance neuronavigation, confirm fenestrations/biopsies, and detect complications.
- It can redefine anatomical changes during surgery.
Purpose of the Study:
- To evaluate the feasibility and utility of intraoperative MRI (iMRI) in neuroendoscopic procedures.
- To assess the benefits of iMRI for neuronavigation and complication detection.
- To explore the value of iMRI in complex hydrocephalus cases.
Main Methods:
- A fully integrated 1.5-T MRI scanner was used in the operating room.
- 11 adult patients underwent endoscopic operations in the iMRI setting between 2007 and 2011.
- Specific MRI sequences (T2 axial, T2 sagittal, TRUFI) were identified as most useful.
Main Results:
- The study included 11 adult patients with diagnoses such as aqueductal stenosis, pineal cyst, third ventricle tumor, and brain abscess.
- Procedures included endoscopic third ventriculostomy, aqueductoplasty, tumor biopsy, and tumor resection.
- Mean scan time was 19 minutes; T2 axial, T2 sagittal, and TRUFI sequences were most useful for catheter placement, complication detection, and fenestration confirmation.
Conclusions:
- Intraoperative MRI (iMRI) provides high-resolution imaging immediately post-endoscopic operation.
- The combined use of iMRI and neuroendoscopy is technically feasible and potentially valuable for complex hydrocephalus.
- Optimal scanning protocols involve T2 axial, T2 sagittal, and TRUFI MR images.
