Purpose: To compare low-field (0.15 T) intraoperative magnetic resonance imaging (iMRI)-guided tumor resection with both conventional magnetic resonance imaging (cMRI)-guided tumor resection and high-field (1.5 T) iMRI-guided resection from the clinical and economic point of view. Materials and Methods:We retrospectively compared 65 iMRI patients with 65 cMRI patients in terms of hospital length of stay, repeat resection rate, repeat resection interval, complication rate, cost to the patient, cost to the hospital, and cost effectiveness. In addition, we compared our low-field results with previously published high-field results.Results: The complication rate was lower for iMRI vs. cMRI in patients presenting for their initial tumor resection (45 vs. 57 complications, P ¼ 0.048). The iMRI repeat resection interval was longer for this cohort (20.1 vs. 6.7 months, P ¼ 0.020). iMRI was more cost-effective than cMRI for patients who had repeat resections ($10,690/ RFY vs. $76,874/RFY, P < 0.001). We found no other clinical or economic differences between iMRI-and cMRIguided tumor resection surgeries. Overall, we did not find the advantages to low-field iMRI that have been reported for high-field iMRI. Conclusion:There is no adequate justification for the widespread installation of low-field iMRI in its current development state.

Post operative nausea and vomiting (PONV) occurs in as many as 70%-80% of high risk surgical patients. The latest prophylactic treatment recommended in the Society of Ambulatory Anesthesia Guidelines for the management of Postoperative Nausea and Vomiting for high risk patients is a combination of 2 or more interventions (multimodal therapy). A combination of a 5-HT 3 receptor antagonist with dexamethasone and/or droperidol, or a 5-HT 3 receptor antagonist with droperidol alone, or dexamethasone with droperidol, have been the pharmacologic combination therapies suggested in these guidelines. Palonosetron is a fairly new 5-HT 3 receptor antagonist recently approved by the FDA for PONV prophylaxis. The use of this novel drug in a triple therapy combination with Dexamethasone and/ or Droperidol could be an effective treatment for the prevention of PONV. However, since the FDA issued a warning stating that droperidol may cause life -threatening arrhythmias as well as a prolongation of the QTc interval, the need to discover new combination therapies for PONV prevention in high risk patients is still in demand. Therefore, we hypothesize that the use of this novel drug Palonosetron in a triple therapy combination with Dexamethasone and Promethazine will be an effective treatment for the prevention of PONV in patients at a high risk for developing PONV during the first 120 hours after neurosurgery.

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