title: First Application of 7-T Magnetic Resonance Imaging in Endoscopic Endonasal Surgery of Skull Base Tumors.
abstract: BACKGROUND
  Successful endoscopic endonasal surgery for the resection of skull base tumors is reliant on preoperative imaging to delineate pathology from the surrounding anatomy. The increased signal-to-noise ratio afforded by 7-T MRI can be used to increase spatial and contrast resolution, which may lend itself to improved imaging of the skull base. In this study, we apply a 7-T imaging protocol to patients with skull base tumors and compare the images with clinical standard of care.
  
  
  METHODS
  Images were acquired at 7 T on 11 patients with skull base lesions. Two neuroradiologists evaluated clinical 1.5-, 3-, and 7-T scans for detection of intracavernous cranial nerves and internal carotid artery (ICA) branches. Detection rates were compared. Images were used for surgical planning and uploaded to a neuronavigation platform and used to guide surgery.
  
  
  RESULTS
  Image analysis yielded improved detection rates of cranial nerves and ICA branches at 7 T. The 7-T images were successfully incorporated into preoperative planning and intraoperative neuronavigation.
  
  
  CONCLUSIONS
  Our study represents the first application of 7-T MRI to the full neurosurgical workflow for endoscopic endonasal surgery. We detected higher rates of cranial nerves and ICA branches at 7-T MRI compared with 3- and 1.5-T MRI, and found that integration of 7 T into surgical planning and guidance was feasible. These results suggest a potential for 7-T MRI to reduce surgical complications. Future studies comparing standardized 7-, 3-, and 1.5-T MRI protocols in a larger number of patients are warranted to determine the relative benefit of 7-T MRI for endonasal endoscopic surgical efficacy.
authors.affiliation: Department of Neurosurgery, Mount Sinai Medical Center, New York, NY, USA. Electronic address: Thomas.barrett@icahn.mssm.edu.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Barrett
authors.affiliation: The Translational and Molecular Imaging Institute, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Hadrien A
authors.initials: HA
authors.lastname: Dyvorne
authors.affiliation: The Translational and Molecular Imaging Institute, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Padormo
authors.affiliation: Department of Radiology, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Puneet S
authors.initials: PS
authors.lastname: Pawha
authors.affiliation: Department of Radiology, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Delman
authors.affiliation: Department of Neurosurgery, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Raj K
authors.initials: RK
authors.lastname: Shrivastava
authors.affiliation: The Translational and Molecular Imaging Institute, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Priti
authors.initials: P
authors.lastname: Balchandani
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D003397:Craniopharyngioma / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008579:Meningioma / Q000000981:diagnostic imaging* / Q000601:surgery; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D044583:Neuroendoscopy / Q000379:methods*; D038361:Neuronavigation / Q000379:methods; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: 7-T MRI; Endoscopic endonasal surgery; Skull base tumors; Ultrahigh-field MRI