Thermal Injuries during Intraoperative Magnetic Resonance Imaging: Mechanisms and Prevention

Background: The extent of resection of eloquent cortex low-grade glioma is improved by intraoperative magnetic resonance imaging (IOMRI) which is faced with challenges such as difficulty in automated registration after the MRI and prolongation of operative time. Objective: We describe an easier and foolproof method of resection using bone wax as fiducial. Surgical Procedure: A young male with right-frontal low-grade glioma anterior and superficial to the motor fibers was operated using IOMRI and awake craniotomy under neuromonitoring. Motor cortex mapping using phase reversal and continuous motor evoked potential (MEP) monitoring was used initially followed by continuous sub-cortical suction stimulation for deeper decompression until stimulation was seen. Bone wax in a triangular shape was placed at the suspicious margin and IOMRI was done. Results: The tumor residue was seen anterior and deeper to the bone wax and removed subsequently. Conclusion: The use of bone wax as a fiducial can aid in IOMRI-guided resection of eloquent cortex glioma in awake patients.

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Anesthetic Concerns during Gamma-Knife Radiosurgery

Tripathi

Chauhan

Luthra

et al. 2023

Neurology India

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Background: Gamma-knife radiosurgery (GKRS) has emerged as one of the mainstream modalities in the treatment of many neurosurgical conditions. The indications for Gamma knife are ever-increasing and presently more than 1.2 million patients have been treated with Gamma knife worldwide. Objective: A neurosurgeon usually leads the team of radiation oncologists, medical physicists, nursing staff, and radiation technologists. Seldom, help from anesthetist colleagues is required in managing patients, who either require sedation or anesthesia. Methods: In this article, we try to elucidate anesthetic considerations in Gamma-knife treatment for different age groups. With the collective experience of authors involved in Gamma-Knife Radiosurgery of 2526 patients in 11 years with a frame-based technique, authors have tried to elucidate an effective and operational management strategy. Results: For pediatric patient (n = 76) population and mentally challenged adult patients (n = 12), GKRS merits special attention given its noninvasive nature but problems of frame fixation, imaging, and claustrophobia during radiation delivery become an issue. Even among adults, many patients have anxiety, fear, or claustrophobia, who require medications either to sedate or anesthetize during the procedure. Conclusion: A major goal in treatment would be a painless frame fixation, avoid inadvertent movement during dose delivery, and a fully wake, painless, and smooth course after frame removal. The role of anesthesia is to ensure patient immobilization during image acquisition and radiation delivery while ensuring an awake, neurologically accessible patient at the end of the radiosurgery.

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Thermal Injuries during Intraoperative Magnetic Resonance Imaging: Mechanisms and Prevention

Cited by 4 publications

References 5 publications

Survival implications of postoperative restricted diffusion in high-grade glioma and limitations of intraoperative MRI detection

Survival implications of postoperative restricted diffusion in high-grade glioma and limitations of intraoperative MRI detection

Bone Wax as an Intra-Cavitary Fiducial for Intra-Operative Magnetic Resonance Imaging Guided Resections of Eloquent Cortex Glioma

Anesthetic Concerns during Gamma-Knife Radiosurgery

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