Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients.
OBJECTIVE
To review the initial clinical experience with intraoperative high-field-strength magnetic resonance (MR) imaging of brain lesions in 200 patients.


METHODS
Two hundred patients (mean age, 46.1 years; range, 7-84 years), most of whom had glioma or pituitary adenoma, were examined with a 1.5-T MR imager equipped with a rotating operating table and located in a radiofrequency-shielded operating theater. A navigation microscope placed inside the 0.5-mT zone and used in combination with a ceiling-mounted navigation system enabled integrated microscope-based neuronavigation. The extent of resection depicted at intraoperative imaging, the surgical consequences of intraoperative imaging, and the clinical practicability of the operating room setup were analyzed.


RESULTS
Seventy-seven resections with a transsphenoidal approach, 100 craniotomies, and 23 burr-hole procedures were performed. In 55 (27.5%) of 200 patients, intraoperative MR imaging had immediate surgical consequences (eg, extension of resection in 39% of patients with pituitary adenoma or glioma). In 108 patients the navigation system was used, and for 37 of those patients, functional imaging data were integrated into the navigation system. There was nearly no difference in quality between pre- and intraoperative images. Intraoperative workflow with intraoperative patient transport for imaging was straightforward, and imaging in most cases began less than 2 minutes after sterile covering of the surgical site. No complications resulted from high-field-strength MR imaging.


CONCLUSIONS
The high-field-strength MR imager was successfully adapted for intraoperative use with the integrated neuronavigation system. Intraoperative MR imaging provided valuable information that allowed intraoperative modification of the surgical strategy.
Nimsky
Christopher
C
Department of Neurosurgery, University Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany. nimsky@nch.imed.uni-erlangen.de
Ganslandt
Oliver
O
Von Keller
Boris
B
Romstöck
Johann
J
Fahlbusch
Rudolf
R
D000236:Adenoma / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000601:surgery*; D001932:Brain Neoplasms / Q000601:surgery; D002648:Child; D003287:Contrast Media; D003397:Craniopharyngioma / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D004827:Epilepsy / Q000601:surgery; D005260:Female; D005910:Glioma / Q000601:surgery; D006801:Humans; D007089:Image Enhancement; D007430:Intraoperative Care; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods; D009873:Operating Rooms / Q000458:organization & administration; D010911:Pituitary Neoplasms / Q000601:surgery; D015642:Radiology, Interventional
D003287:Contrast Media