Preliminary experience in glioma surgery with intraoperative high-field MRI.
OBJECTIVE
To apply a new setup, combining the benefits of high-field magnetic resonance imaging (MRI) with microscope-based neuronavigation, providing anatomical and functional guidance, in glioma surgery.


METHODS
MR imaging was performed using a 1.5 T scanner, located in a radiofrequency-shielded operating theatre. The patient is lying on a rotating operating table, which is locked at the 160 degree position for surgery at the 5 G zone and turned into the scanner for imaging. The microscope, placed in the 5 G zone, in combination with a ceiling mounted navigation system enables microscope-based neuronavigation; integrated data from magnetoencephalography and functional MRI provide functional guidance.


RESULTS
126 patients were investigated with intraoperative high-field MRI, among them were 37 patients with gliomas. In the biopsy/catheter group (n = 8) MRI reliably depicted the needle position or the location of catheter placement. In the group with glioma resection (n = 29) intraoperative MRI revealed that the surgical objective was not achieved in 28%, leading to further tumour removal. We did not observe complications attributable to intraoperative high-field MRI. Image quality was not diminished by the operating room equipment, so that there was nearly no noticeable difference between pre- and intraoperative image quality. Neuronavigational guidance was applied in 31 patients: the integrated use of functional data prevented an increased morbidity despite extended resections.


CONCLUSIONS
Intraoperative high-field MRI allows a reliable delineation of the extent of resection in glioma surgery. If the surgical objective was not met, a modification of the surgical strategy during the same operation is possible, thus leading to more radical resections. Furthermore, high-field MRI offers increased image quality and a much broader spectrum of different imaging modalities, compared to previous intraoperative low-field systems.
Nimsky
C
C
Department of Neurosurgery, University Erlangen-Nürnberg, Erlangen, Germany. nimsky@nch.imed.uni-erlangen.de
Ganslandt
O
O
von Keller
B
B
Fahlbusch
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000295:instrumentation; D001921:Brain / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D004867:Equipment Design; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery; D038361:Neuronavigation / Q000295:instrumentation*; D012189:Retrospective Studies; D016896:Treatment Outcome