Interactive magnetic resonance imaging-guided management of intracranial cystic lesions by using an open magnetic resonance imaging system.
OBJECTIVE
The authors present their experience with neurosurgical procedures requiring real-time imaging feedback such as aspiration of a cystic structure or abscess cavity, decompression of hydrocephalic ventricles, management of arachnoid cysts, and installation of permanent or temporary drainage conduits, in which interactive magnetic resonance (MR) imaging guidance was used to monitor structural alterations associated with the procedure.


METHODS
Drainage of eight intraparenchymal brain abscesses in seven patients, decompression of space-occupying cystic or necrotic brain tumors in four patients, and endoscopic management of hydrocephalus associated with arachnoid cysts in three patients were performed using MR imaging-guided frameless stereotaxy in an open-configuration 0.5-tesla superconducting MR imaging system. Intraoperative MR imaging guidance provided accurate information on the course of the surgical procedure and associated intraoperative changes in tissue position, such as the degree of cyst aspiration, the presence or absence of hemorrhage or induced swelling, and changes associated with decompression of adjacent brain parenchyma and the ventricular system. No clinically significant complications were encountered in any patient. There were no targeting errors, and procedural objectives were accomplished in all cases.


CONCLUSIONS
Drainage of brain abscesses, punctures of cystic or necrotic intracranial lesions with subsequent aspiration, and management of hydrocephalus can be performed safely and accurately by monitoring the procedure using real-time MR imaging to obtain immediate feedback on associated dynamic tissue changes.
Kollias
S S
SS
Institute of Neuroradiology and Department of Neurosurgery, University Hospital of Zurich, Switzerland. kollias@dmr.usz.ch
Bernays
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RL
D000328:Adult; D000368:Aged; D016080:Arachnoid Cysts / Q000175:diagnosis / Q000601:surgery; D001922:Brain Abscess / Q000175:diagnosis / Q000601:surgery*; D001927:Brain Diseases / Q000175:diagnosis / Q000601:surgery*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D019299:Decompression, Surgical / Q000295:instrumentation; D004322:Drainage / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000601:surgery; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D014584:User-Computer Interface