title: Assessing perioperative complications associated with use of intraoperative magnetic resonance imaging during glioma surgery - a single centre experience with 516 cases.
abstract: BACKGROUND
  Intraoperative magnetic resonance imaging (io-MRI) improves the extent of glioma resection. Due to the magnetic field, patients have to be covered with sterile drape and are then transferred into an io-MRI chamber, where ferromagnetic anaesthesia monitors and machines must be kept at distance and can only be applied with limitations. Despite the development of specific paramagnetic equipment for io-MRI use, this method is suspected to carry a higher risk for anaesthesiological and surgical complications. Particularly, serial draping and un-draping cycles as well as the extended surgery duration might increase the risk of perioperative infection.
  
  
  OBJECTIVE
  Given the importance of io-MRI for glioma surgery, the question regarding io-MRI safety needs to be answered.
  
  
  METHODS
  We prospectively evaluate the perioperative anaesthesiological and surgical complications for 516 cases of brain tumour surgery involving io-MRI (MRI cohort). As a control group, we evaluate a cohort of 610 cases of brain tumour surgery, performed without io-MRI (control group).
  
  
  RESULTS
  The io-MRI procedure (including draping/undraping, transfer to and from the MRI cabinet and io-MRI scan) significantly extended surgery, defined as "skin to skin" time, by 57 min (SD = 16 min) (p ≤ 0.01). Still, we show low and comparable rates of surgical complications in the MRI cohort and the control group. Postoperative haemorrhage (3.7% versus 3.0% in MRI cohort versus control group; p = 0.49) and infections (2.2% versus 1.8% in MRI cohort versus control group; p = 0.69) were not significantly different between both groups. No anaesthesiological disturbances were reported.
  
  
  CONCLUSIONS
  Despite prolonged surgery and serial draping and un-draping cycles, io-MRI was not linked to higher rates of infections and postoperative haemorrhage in this study.
authors.affiliation: a Department of Neurosurgery , University of Heidelberg , Heidelberg , Germany.
authors.forename: Rezvan
authors.initials: R
authors.lastname: Ahmadi
authors.affiliation: a Department of Neurosurgery , University of Heidelberg , Heidelberg , Germany.
authors.forename: Benito
authors.initials: B
authors.lastname: Campos
authors.affiliation: a Department of Neurosurgery , University of Heidelberg , Heidelberg , Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Haux
authors.affiliation: a Department of Neurosurgery , University of Heidelberg , Heidelberg , Germany.
authors.forename: Jörn
authors.initials: J
authors.lastname: Rieke
authors.affiliation: a Department of Neurosurgery , University of Heidelberg , Heidelberg , Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Beigel
authors.affiliation: a Department of Neurosurgery , University of Heidelberg , Heidelberg , Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Unterberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D038361:Neuronavigation / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Complications; glioma; intraoperative MRI; surgery