Intraoperative MRI without an intraoperative MRI suite: a workflow for glial tumor surgery

Area of Science:

• Neurosurgery
• Radiology
• Medical Imaging

Background:

• Intraoperative MRI (iMRI) enhances glioma resection extent but requires dedicated operating rooms.
• Dedicated iMRI suites present physical and economic challenges for many medical centers.
• Alternative iMRI methods are needed for broader accessibility in neuro-oncology.

Purpose of the Study:

• To assess the feasibility of utilizing a non-dedicated MRI scanner for iMRI in glioma surgery.
• To evaluate the workflow, time efficiency, and surgical implications of this alternative iMRI approach.
• To determine the safety and effectiveness of iMRI performed outside the traditional operating room setting.

Main Methods:

• 24 patients with glioma underwent surgery with iMRI using a non-dedicated scanner in the radiology department.
• Patients were transferred for iMRI after initial resection, followed by return to the OR for completion.
• Procedural times, including transfer and scanning, and adverse events were meticulously recorded.

Main Results:

• Median time from iMRI decision to wound reopening was 68 minutes.
• Residual tumors were detected in 54% of patients via iMRI.
• No adverse events or complications (surgical, transport, or infection-related) were reported.

Conclusions:

• Intraoperative MRI using a non-dedicated scanner outside the OR is a safe and feasible procedure.
• This method demonstrates comparable time efficiency to dedicated iMRI systems.
• It presents a practical alternative for centers without dedicated iMRI facilities.