Intraoperative imaging in a comprehensive neuronavigation environment for minimally invasive brain tumour surgery.
BACKGROUND
Development of an image-guided operation theatre offering multimodal information for mini-invasive neurosurgical brain tumour operations.


METHODS
A multi-purpose resistive low-field MR scanner with on-off capability, was installed in a radio frequency-shielded operating room with in-room control panel and display. Intraoperative ultrasound imaging with Doppler mode as needed is used to provide check-up image data between intraoperative MR-imaging sessions. Cortical stimulation and registration are performed during awake craniotomies. The neuronavigation systems are customised arm-based and passive optical. The navigation systems show the positions of the ultrasound probe, cortical stimulation electrode, biopsy needles, endoscope and other instruments on the intraoperative MR-images.


RESULTS
Since 1999, 70 patients (mean age 47, range 3-88 years) have been operated with intraoperative MR-guidance (including 10 tumour biopsies, 56 resections). Twenty-one patients (mean age 46, range 16-67 years) underwent awake craniotomy and tumour resection secured with cortical stimulation and usually preoperative fMR-imaging. The present operating environment offered useful multimodal information for surgery of brain tumours in critical locations. Surgical mortality was 0%, morbidity included 3 (4.3%) infections and 2 (2.9%) permanent hemiparesis. Further removal of tumour was continued in 17 cases (57%) out of the 30 cases where intraoperative MR imaging was used for controlling completeness of the resection.
Tuominen
J
J
Department of Neurosurgery, Oulu University Hospital, Oulu, Finland.
Yrjänä
S K
SK
Katisko
J P
JP
Heikkilä
J
J
Koivukangas
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001921:Brain / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004453:Echoencephalography / Q000295:instrumentation*; D004569:Electroencephalography / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D016343:Monitoring, Intraoperative / Q000295:instrumentation; D038361:Neuronavigation / Q000295:instrumentation*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D012680:Sensitivity and Specificity