MRI‐guided stereotactic neurosurgical procedures in a diagnostic MRI suite: Background and safe practice recommendations

Abstract

The development of navigation technology facilitating MRI-guided stereotactic neurosurgery has enabled neurosurgeons to perform a variety of procedures ranging from deep brain stimulation to laser ablation entirely within an intraoperative or diagnostic MRI suite while having real-time visualization of brain anatomy. Prior to this technology, some of these procedures required multisite workflow patterns that presented significant risk to the patient during transport. For those facilities with access to this technology, safe practice guidelines exist only for procedures performed within an intraoperative MRI. There are currently no safe practice guidelines or parameters available for facilities looking to integrate this technology into practice in conventional MRI suites. Performing neurosurgical procedures in a diagnostic MRI suite does require precautionary measures. The relative novelty of technology and workflows for direct MRI-guided procedures requires consideration of safe practice recommendations, including those pertaining to infection control and magnet safety issues. This article proposes a framework of safe practice recommendations designed for assessing readiness and optimization of MRI-guided neurosurgical interventions in the diagnostic MRI suite in an effort to mitigate patient risk. The framework is based on existing clinical evidence, recommendations, and guidelines related to infection control and prevention, health care-associated infections, and magnet safety, as well as the clinical and practical experience of neurosurgeons utilizing this technology.

The interventional magnetic resonance imaging suite: Experience in the design, development, and implementation in a pre-existing radiology space and review of concepts

“…A detailed description of the cross-training of both MR and surgical personnel is beyond the scope of this article, and the essential elements required have been previously outlined by Larson et al . [16,17] This cross-training is critical for any iMRI program and represented one of the biggest challenges in the early phases of the iMRI program at our institution.…”

“…Since the development of the first intraoperative magnetic resonance imaging (MRI) (ioMRI) units in the 1980s,[20] ioMRI has allowed for advances in the real-time imaging during surgeries,[13] improvement in accuracy and safety of procedures,[3,6,17,20-23,27,29] and offered less invasive alternatives for the treatment of lesions in the brain. [10,18,20,24] The costs associated with the development and buildout of intraoperative units in the surgical suite, as well as the limitations in the recuperation of these costs, have hampered the expansion of this technology in most institutions.…”

Feasibility and performance of a frameless stereotactic system for targeting subcortical nuclei in nonhuman primates

“…6,30 In addition, many frameless adaptors used in animal research have been developed for intraoperative MRI guidance, 28,30 an emerging technique that presents high costs, several restrictions, and is not widely available, especially in a preclinical scenario. 20 Furthermore, many of these stereotactic devices have been built for specific neurosurgical procedures 10,15,24,30 and it is incorrect to infer easy and direct adaptability of these devices to DBS lead implantation.…”

Learning: New avenues and new topics

“…They cover topics including: Legal strategies in the wake of a “never event.” Using multimodal analgesia as a safer alternative to opioids alone MRI‐guided stereotactic neurosurgical procedures in a diagnostic MRI suite Managing the risk of head impact as a result of patient falls …”