Brain Biopsy Using High-Field Strength Interventional Magnetic Resonance Imaging

Abstract

Interventional 1.5-T MRI is a safe and effective method for evaluating lesions of the brain. Magnetic resonance spectroscopic targeting is likely to augment the diagnostic yield of brain biopsies.

Frameless Stereotactic Surgery Using Intraoperative High-Field Magnetic Resonance Imaging

“…This overall diagnostic yield of 100% is only a preliminary value based on 19 patients, but falls within the range for conventional frameless stereotaxy 8) and iMR imaging, with a diagnostic yield of 96-100%. 2,9,10,16,26) The morbidity and mortality in our series were both 0%, but we observed two cases of wound infection, one needing surgical revision. The incidence of surgical site infection is 4% in patients who underwent craniotomies in conventional operating rooms.…”

“…Frameless stereotaxy has been performed interactive with near-real time iMR imaging that allowed for direct visualization of the instruments. 3,9,10) In our series, the aim of the procedure was not affected by brain shift in any patient. Moreover, if intraoperative shift of the target occurred and histological yield was not achieved, iMR imaging could depict the reasons for failure of targeting and allowed us to visualize the correct target by re-registration of neuronavigation within few minutes.…”

“…10,28) However, we should clearly emphasize that with our described setup a smooth intraoperative workflow is guaranteed and updating of neuronavigation with intraoperative data for repeated biopsy attempts is possible. Just to place catheters in cysts would not justify purchasing a high-field magnet because such procedures should be possible either with low-field MR scanners or mobile computed tomography (CT), which have a clear advantage over the high-field MR scanner in view of cost effectiveness.…”

“…Two different approaches to the clinical application of iMR imaging have been reported: low-field iMR imaging for stereotactic procedures because of the easy access to patients due to the open configuration, 2,16,25,26) and high-field MR imaging. 10,28) However, use of these systems for frameless stereotaxy is limited to restricted institutions, so whether this approach definitely improves clinical outcomes and reduce complication rates is not yet established. Encouraged by our previous experience with low-field iMR imaging, 18,21,27) we began to develop a concept integrating high-field MR imaging with an in-room neuronavigation system for frameless stereotaxy into the operation theater in close collaboration with Siemens Medical Solutions (Erlangen, Germany) and BrainLAB (Heimstetten, Germany).…”

Intraoperative Magnetic Resonance Imaging: Impact on Brain Tumor Surgery

“…31 Biopsies can be performed using stereotactic frames or frameless systems, but iMRI-guided biopsy offers some distinct advantages. 24,32 Multiple targets may be selected with ease, which is a cumbersome process with a frame. Updated imaging can allay any concerns regarding registration accuracy or possible brain shifts that might occur (for instance, with drainage of a cyst).…”