Intraoperative Diagnostic and Interventional Magnetic Resonance Imaging in Neurosurgery

Tronnier, V.; Wirtz, Christian Rainer; Knauth, Michael; Lenz, G.; Pastyr, O.; Bonsanto, Mario M.; Albert, Friedrich K.; Kuth, Rainer; Staubert, Andreas; Schlegel, Wolfgang; Sartor, Klaus; Kunze, Stefan

doi:10.1097/00006123-199705000-00001

Cited by 245 publications

(95 citation statements)

References 31 publications

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“…The high magnetic field strength of this system provides rapid, high-resolution images necessary to visualize specific temporal lobe structures fully. This may not be matched with lower-field-strength systems (18)(19)(20).…”

Section: Discussionmentioning

confidence: 96%

Optimizing Epilepsy Surgery with Intraoperative MR Imaging

Kaibara¹,

Myles²,

Lee

et al. 2002

Epilepsia

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Summary: Purpose:The surgical treatment of medically intractable temporal lobe epilepsy includes the resection of temporal lobe structures. Although the reported seizure-free outcomes are highly variable, there is growing evidence that the extent of resection of the mesiotemporal lobe directly correlates with seizure control.Methods: A moveable, high-field intraoperative magnetic resonance (MR) system was used to monitor and optimize the resection of the amygdala and hippocampus in 14 epilepsy patients. Fourteen patients with intractable seizures of temporal lobe origin underwent standard preoperative investigations including MR imaging, EEG telemetry, single-photon emission computed tomography, and neuropsychologic and sodium amytal testing. Anterior temporal lobectomy was performed on 10 patients, whereas four were treated with selective amygdalohippocampectomy. Intraoperative electrocorticography was applied as required. For all procedures, the objective was to resect the amygdala completely, and hippocampus to the posterior margin of the brainstem.Results: Interdissection intraoperative MR imaging taken when optimal resection was thought to have been achieved revealed residual unresected amygdala or hippocampus in seven of 14 patients. An unexpected acute hematoma was found in one patient. At 17 months' follow-up, 13 (93%) of 14 patients are seizure free or have significantly improved seizure control.Conclusions: The mobile high-field intraoperative MR system provides high-resolution images without restriction on surgical instruments or techniques. The ability to identify and resect residual mesial temporal lobe targets before craniotomy closure is of potentially tremendous value in optimizing seizure control.

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Section: Discussionmentioning

confidence: 96%

Optimizing Epilepsy Surgery with Intraoperative MR Imaging

Kaibara¹,

Myles²,

Lee

et al. 2002

Epilepsia

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“…Instead of using the double-donut setup, which requires that the surgeon is within the magnetic field thus requiring non-magnetic tools [6] , "twin operating theatres" have been proposed for both low [13,14] and more recently high field systems, with the need to transfer the patient between the imaging and surgical site. This has become the setup of choice in most institutions [8,15,16] , although some move the magnet towards the surgical site [17] .…”

Section: Intraoperative Setupmentioning

confidence: 99%

Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures

Ulmer¹

2014

WJR

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The goal in brain tumor surgery is to remove the maximum achievable amount of the tumor, preventing damage to "eloquent" brain regions as the amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve this goal, a variety of technical advances have been introduced, including an operating microscope in the late 1950s, computer-assisted devices for surgical navigation and more recently, intraoperative imaging to incorporate and correct for brain shift during the resection of the lesion. However, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired magnetic resonance images. To overcome this uncertainty, perfusion techniques [dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI)] have been introduced that can differentiate residual tumor from surgically induced changes at the rim of the resection cavity and thus overcome this remaining uncertainty of intraoperative MRI in high grade brain tumor resection.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words:Intraoperative magnetic resonance imaging; Dynamic susceptibility contrast magnetic resonance imaging; Dynamic contrast enhanced magnetic resonance imaging; Surgically induced contrast enhancement; Neurosurgery Core tip: The amount of brain tumor resection is one of the prognostic factors for time to tumor progression and median survival. To achieve maximum brain tumor removal, while preventing damage to "eloquent" brain regions, a variety of technical advances have been introduced, including intraoperative magnetic resonance imaging. Brain shift can thus be compensated; however, surgically induced contrast enhancement along the rim of the resection cavity hampers interpretation of these intraoperatively acquired images. Recently, perfusion techniques (dynamic contrast enhanced magnetic resonance imaging, dynamic susceptibility contrast magnetic resonance imaging) have been introduced that can differentiate residual tumor from surgically induced changes and thus overcome this remaining uncertainty in high grade brain tumor resection.Ulmer S. Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures. World

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“…Intraoperative CT and MRI have been integrated since the last decade into the operating room [12]. Starting with low-field systems between 0.02 -0.5 Tesla [13] and open MRI scanners [14], high-field systems were introduced starting in 2000 [15]. In a controlled randomized study with a low-field system, Senft et al [16] detected 96 % gross tumor resection in the patient group who were investigated by ioMRI, versus 68 % gross total resection in the control group.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of High-Field Intraoperative MRI in the Detectability of Residual Tumor in Glioma Grade IV Resections

Heßelmann

Mager

Goetz

et al. 2017

Fortschr Röntgenstr

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Objective To assess the sensitivity/specificity of tumor detection by T1 contrast enhancement in intraoperative MRI (ioMRI) in comparison to histopathological assessment as the gold standard in patients receiving surgical resection of grade IV glioblastoma. Materials and Methods 68 patients with a primary or a recurrent glioblastoma scheduled for surgery including fluorescence guidance and neuronavigation were included (mean age: 59 years, 26 female, 42 male patients). The ioMRI after the first resection included transverse FLAIR, DWI, T2-FFE and T1 – 3 d FFE +/- GD-DPTA. The second resection was performed whenever residual contrast-enhancing tissue was detected on ioMRI. Resected tissue samples were histopathologically evaluated (gold standard). Additionally, we evaluated the early postoperative MRI scan acquired within 48 h post-OP for remaining enhancing tissue and compared them with the ioMRI scan. Results In 43 patients ioMRI indicated residual tumorous tissue, which could be confirmed in the histological specimens of the second resection. In 16 (4 with recurrent, 12 with primary glioblastoma) cases, ioMRI revealed truly negative results without residual tumor and follow-up MRI confirmed complete resection. In 7 cases (3 with recurrent, 4 with primary glioblastoma) ioMRI revealed a suspicious result without tumorous tissue in the histopathological workup. In 2 (1 for each group) patients, residual tumorous tissue was detected in spite of negative ioMRI. IoMRI had a sensitivity of 95 % (94 % recurrent and 96 % for primary glioblastoma) and a specificity of 69.5 % (57 % and 75 %, respectively). The positive predictive value was 86 % (84 % for recurrent and 87 % for primary glioblastoma), and the negative predictive value was 88 % (80 % and 92 %, respectively). Conclusion ioMRI is effective for detecting remaining tumorous tissue after glioma resection. However, scars and leakage of contrast agent can be misleading and limit specificity. Key points Citation Format

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Intraoperative Diagnostic and Interventional Magnetic Resonance Imaging in Neurosurgery

Cited by 245 publications

References 31 publications

Optimizing Epilepsy Surgery with Intraoperative MR Imaging

Optimizing Epilepsy Surgery with Intraoperative MR Imaging

Intraoperative perfusion magnetic resonance imaging: Cutting-edge improvement in neurosurgical procedures

Accuracy of High-Field Intraoperative MRI in the Detectability of Residual Tumor in Glioma Grade IV Resections

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