Clinical Indications for High-Field 1.5 T Intraoperative Magnetic Resonance Imaging and Neuro-navigation for Neurosurgical Procedures -Review of Initial 100 Cases-

Abstract

Initial experiences are reviewed in an integrated operation theater equipped with an intraoperative high-field (1.5 T) magnetic resonance (MR) imager and neuro-navigation (BrainSUITE  ), to evaluate the indications and limitations. One hundred consecutive cases were treated, consisting of 38 gliomas, 49 other tumors, 11 cerebrovascular diseases, and 2 functional diseases. The feasibility and usefulness of the integrated theater were evaluated for individual diseases, focusing on whether intraoperative images (including diffusion tensor imaging) affected the surgical strategy. The extent of resection and outcomes in each histological category of brain tumors were examined. Intraoperative high-field MR imaging frequently affected or modified the surgical strategy in the glioma group (27/38 cases, 71.1%), but less in the other tumor group (13/49 cases, 26.5%). The surgical strategy was not modified in cerebrovascular or functional diseases, but the success of procedures and the absence of complications could be confirmed. In glioma surgery, subtotal or greater resection was achieved in 22 of the 31 patients (71%) excluding biopsies, and intraoperative images revealed tumor remnants resulting in the extension of resection in 21 of the 22 patients (95.4%), the highest rate of extension among all types of pathologies. The integrated neuro-navigation improved workflow. The best indication for intraoperative high-field MR imaging and integrated neuro-navigation is brain tumors, especially gliomas, and is supplementary in assuring quality in surgery for cerebrovascular or functional diseases. Immediate quality assurance is provided in several types of neurosurgical procedures.

The role of early intra-operative MRI in partial resection of optic pathway/hypothalamic gliomas in children

“…The benefits of being able to reassess surgical goals, and update neuronavigation, thereby counteracting brainshift potentially allows for more accurate and more efficacious tumour resection in both adults and children [1,3,4,14,19,20,21,23,26,27,29].…”

“…Incorporating ioMRI with neuronavigation for tumour resection in the adult population has been shown to have a synergistic effect on resection because ioMRI allows the neuronavigation system to be updated intra-operatively, counteracting brainshift and allowing the surgical aim to be modified accordingly to safety considerations or new surgical goals [19,23,27,29]. There is limited evidence for the use of ioMRI in the paediatric population, and we have previously demonstrated that ioMRI has increased the rate of complete resections, with intraoperative surgical strategy being modified in 30% of procedures in our series of 40 cranial tumours [3,4,37].…”

3-T ultrahigh-field intraoperative MRI for low-grade glioma resection

“…Similar designs were developed for high-field systems [23]. Siemens ioMRI design reverted to a single dedicated operating room in the Siemens 1.5-T brain suite design [11,24]. The latest system by Siemens, installed at our institution, again used the twin-room philosophy to reduce costs by allocating the equipment to diagnostic out-patient imaging at times when MRI is not needed intraoperatively [17,18].…”

“…The conclusions after 10 years of experience with ioMRI for neurosurgery are as follows [2,5,8,9,11,13,14,17,[21][22][23][24][25][26]. Current ioMRI technology has very high anatomical resolution but also provides functional information (e.g., functional MRI, DWI, magnetic resonance spectroscopy, diffusion tensor imaging, magnetic resonance angiography and magnetic resonance venography).…”

Intraoperative Magnetic Resonance Imaging in the Successful Surgical Treatment of an Arteriovenous Malformation-Case Report-

“…1,[3][4][5][6] iMR imaging can provide updated information on anatomy and on unanticipated brain events, so allowing safer and more accurate surgery. [10][11][12] Interoperative timeresolved imaging of contrast-kinetics (iTRICKS) can provide high spatial and temporal resolution during iMR imaging. We describe the efficacy of iMR imaging and iTRICKS during AVM surgery with a fully integrated 1.5 T neurosurgical system with neuronavigation and intraoperative imager.…”